Birmingham Women's NHS Foundation Trust, Birmingham, B15 2TG UK; University of Birmingham, B15 2TT UK.
Birmingham Women's NHS Foundation Trust, Birmingham, B15 2TG UK.
J Gynecol Obstet Hum Reprod. 2023 May;52(5):102567. doi: 10.1016/j.jogoh.2023.102567. Epub 2023 Mar 1.
To evaluate perioperative outcomes and symptom resolution in women undergoing Essure removal.
Single centre cohort study at a large University Teaching Hospital in the UK. Symptoms and Quality of life (QoL) were assessed using a standardised questionnaire administered at 6-months and up to 10-years following removal of Essure® devices.
61 women underwent surgical removal of Essure® devices representing 61/1087 (5.6%) of all women undergoing this hysteroscopic form of sterilization. Patients who had Essure® removal were more likely to have a previous caesarean section [38% vs 18%; OR 0.4, 95% CI 0.2-0.6; P <0.001]. The main indication for removal was pelvic pain (49/61, 80%). Removal was achieved by laparoscopic bilateral salpingectomy/cornuectomy (44/61,71%) or hysterectomy (17/61, 28%). At surgery, perforated device was seen in 4/61 (7%) cases. 26/61 (43%) of patients had concomitant pelvic pathology; 12/26 (46%) had fibrous adhesions, 8/26 (31%) endometriosis, 4/26 (15%) adenomyosis, and 2/26 (8%) had endometriosis and adenomyosis. 10 patients underwent further procedure following removal for ongoing symptoms. 55/61 women (90%) responded to the post removal symptom questionnaire. Most respondents to the quality of life survey 42/55 (76%) reported total or some improvement. 42/53 (79%) had total or some improvement in pelvic pain, 9/13 (69%) in mental health and 10/12 (83%) in bleeding.
Surgical removal of Essure® devices appears to improve symptoms thought to be attributable to the presence of these uterine implants in most women. However, patients should be counselled that one in five women may experience persistent or even worsening symptoms.
评估行 Essure 取出术女性的围手术期结局和症状缓解情况。
在英国一家大型大学教学医院进行的单中心队列研究。使用标准化问卷在 Essure®装置取出后 6 个月及长达 10 年时评估症状和生活质量（QoL）。
61 名女性接受了 Essure®装置的手术取出，占所有接受这种宫腔镜绝育方式的 1087 名女性的 61/1087（5.6%）。行 Essure®取出术的患者更有可能有剖宫产史[38%比 18%；比值比 0.4，95%置信区间 0.2-0.6；P<0.001]。取出的主要指征是盆腔疼痛（49/61，80%）。取出术通过腹腔镜双侧输卵管切除术/Cornu 切除术（44/61，71%）或子宫切除术（17/61，28%）完成。在手术中，发现 4/61（7%）例设备穿孔。61 例患者中有 26/61（43%）合并盆腔病变；12/26（46%）有纤维粘连，8/26（31%）有子宫内膜异位症，4/26（15%）有子宫腺肌病，2/26（8%）有子宫内膜异位症和子宫腺肌病。10 名患者在取出后因持续症状而进一步进行了手术。61 名女性中有 55/61（90%）回复了取出后症状问卷。接受生活质量调查的 55 名女性中有 42/55（76%）报告完全或部分改善。42/53（79%）盆腔疼痛完全或部分改善，9/13（69%）心理健康改善，10/12（83%）出血改善。
行 Essure®装置的手术取出似乎可改善大多数女性认为与这些子宫内植入物有关的症状。然而，应告知患者，五分之一的女性可能会持续出现甚至恶化的症状。
