腹腔镜在宫内节育器异位诊治中的应用

Application of laparoscope in diagnosis and treatment of ectopic IUD

目的观察宫内节育器(intrauterine device,IUD)的发生情况,评估腹腔镜在IUD异位诊治中的应用价值.方法选取1995年1月～2005年4月该院以IUD异位而收治住院的22例病例进行回顾性分析,其中行腹腔镜手术取出9例.选取同期因其他妇科疾病住院病人中IUD正常的病例20例为对照组.结果IUD异位组与对照组对比,上环时间、有无痛经史、哺乳期上环例数、是否疤痕子宫、子宫位置等因素无差异(P＞0.05),IUD异位组省级以下医院上环例数明显高于对照组(P=0.000);B超定位IUD异位的符合率为54.55%;腹腔镜取环组与经阴道组、经腹组比较,手术时间短,术中失血量少,术后住院时间短(P＜0.05).结论加强基层医院和个体诊所的管理及人员培训是预防IUD异位的关键.对可疑IUD异位者应进行多项辅助检查确诊、定位.腹腔镜是诊治节育器腹腔内异位的最佳的手段,值得推广.

[Objective] To observe the occurring situation of the IUD and access the value of the laparoscope in diagnosis and treatment of entopic IUD. [Methods] A retrospective study from 1995 to 2005 was carried out with 22 patients who were admitted to our hospital for ectopic IUD, 9 of the 22 cases were performed laparoscopic extraction. 20 cases that have normal IUD and were hospitalized because of other gynecologic disease at the same period were selected as control group. To record the age, the history of gynecologic operation, the hospital of fitting with IUD, the time of fitting with IUD, the symptom after fitting with IUD, the method of finding ectopic IUD, diagnostic procedure, the removal style of IUD, the position of ectopic IUD, the type of ectopic IUD, the operation time, postoperative hospital stay, bleeding amount in operation, complication and so on. According to the difference of the removal style of IUD, we divide 22 cases of ectopic IUD into 3 groups （6 cases of abdominal group,7 cases of vaginal group,9 cases of laparoscopic group）and comparative analyse operation time, bleeding amount in operation, postoperative hospital stay, postoperative complication and so on. [Results] Making comparison between the ectopic group and control group, there is no significant difference in the time of fitting with IUD, having dysme, norrhoa or not, the fitting cases in lactation, scarred uterus or not, the position of the uterus and so on （P 〉0.05）, the fitting cases of the ectopic IUD are more than control group significantly in the hospital of inferior provincial level （P =0.000）; the coincidence rate of B-ultrasound located ectopic IUD is 54.55 percent; laparoscopic group has superiority in shorter operation time , less bleeding amount in operation, shorter postoperative hospital stay （P 〈0.05）, compared with vaginal group and abdominal group, [ Conclusions ] Management and personnel training of the primary hospital and the individual clinic are the key to avoid the ectopic IUD. Patients suspected with ectopic IUD should be diagnosed and located by more assistant examination. Laparoscope must be the first choice of diagnosis and treatment of ectopic IUD which removed to abdominal cavity. It is worthy of being popularized.