宫内节育器异位及嵌顿66例临床分析

Clinical analysis on 66 patients with ectopic or incarcerated intrauterine devices

目的探讨宫内节育器(IUD)异位及嵌顿的诊断、处理及预防。方法回顾性分析2007年1月至2012年6月郑州大学第一附属医院收治的66例IUD异位及嵌顿患者的临床资料。结果 66例患者临床表现不一,常见症状为下腹疼痛及异常子宫出血。其中14例为绝经后妇女,52例为生育期妇女。19例为产后及流产后放置,47例为正常月经后放置。3例为IUD术后异位妊娠手术中诊断,6例为放置IUD后妊娠流产中未发现IUD术后诊断,26例取器困难超声或宫腔镜诊断。T形IUD39例,圆形IUD16例,宫形IUD9例,吉尼环2例。部分嵌顿经宫腔镜或在超声引导下取出18例;部分嵌顿经宫腔镜或超声引导下取器失败者,经皮肾镜由异物钳取出5例;绝经后妇女行子宫切除2例;T形IUD纵臂部分嵌顿子宫颈管,宫腔镜检查后用长弯钳取出5例;宫型及T型IUD嵌顿于子宫壁达子宫浆膜层,腹腔镜或宫腹腔镜联合取出10例;异位于子宫直肠陷凹,超声引导后穹隆切开取出2例;异位于腹腔或盆腔内,经腹腔镜取出17例;异位妊娠术中发现并取出3例;阔韧带异位者腹腔镜取出1例;异位于膀胱内者经皮肾镜取出3例。结论超声或宫腔镜、盆腔X线检查是诊断IUD异位及嵌顿的主要手段,宫腔镜、超声引导、腹腔镜及经皮肾镜是取出IUD的有效手段。

Objective To evaluate the diagnosis, treatment and prevention of ectopic or incarcerated intrauterine devices （IUD）. Methods We analyzed the clinical manifestation and treatment of 66 patients diagnosed as ec- topic or incarcerated IUDs who admitted in the first affiliated hospital of Zhengzhou University from January 2007 to June 2012. Results The common symptoms caused by ectopic or incarcerated IUDs were lower abdominal pain or discomfort and abnormal uterine bleeding. 19 cases occurred after placing IUD after delivery or abortion. 14 cases were postmenopausal women. 2 cases were found after placing Jini ring. 3 cases were diagnosed during surgery of ectopic pregnancy. 2 cases were diagnosed because of IUD disappeared in abortion surgery. 26 cases were confirmed by sonography or hysteroscopy due to difficulty in extracting IUDs. 18 cases of incarcerated IUDs partly in uterine wall were extracted successfully through hysteroscopy or under the surveillance of sonography. 5 cases of incarcera- ted IUDs were removed by percutaneous nephroscope set after failure by sonography and hysteroscopy. 2 cases of postmenopausal women received hysterectomy. 5 cases of IUDs with vertical arms incarcerated in cervical canal were grasped and taken out by long curly hemostatic forceps. 10 cases of uterine- shape or T- shape IUDs incarcerated out of uterine surface. 2 eases of ectopic IUDs in Douglas cul - de- sac were removed by culdotomy. 17 cases of ec- topic IUDs in abdominal or pelvic cavity were taken out by laporoscopy and 3 cases were through laporotomy. 1 case of ectpic IUDs in broad ligament was extracted by laporoscopy, too. 3 cases of ectpic IUDs in bladder were removed by pereutaneous nephroscope set. Conclusion Ectopic ILrDs can be diagnosed effectively under the help of sonography, hysteroscopy and pelvic X Ray. Hysteroseopy, surveillance of sonography, laparoscopy, and percutaneous ne phroscope,set are effective means to successfully remove the eetopic or incarcerated IUDs.