宫内节育器取出困难相关因素分析

Correlation Factors Analysis on Difficult Removal of Intrauterine Device

目的:分析宫内节育器(IUD)取出困难的相关因素。方法:选择1 960例取器妇女临床资料,分析取器年龄、有无人工流产史和妇科疾病史、IUD类型、放置年限、B超检查结果、置器和取器时机、IUD嵌顿、子宫位置与取器困难的关系。结果:取器困难组年龄高于取器容易组;采用金属单环或无尾丝IUD的取器困难比例增加;取器困难者放置IUD年限较长;围绝经期发生取器困难的比例较高,嵌顿可能是造成取器困难的重要原因;子宫后位组取器困难的比例高于子宫前位或中位组;Logistic回归分析表明,IUD无尾丝[2.985(1.555,5.714)]、IUD放置年限[1.042(1.008,1.078)]、取器时机[3.310(2.171,5.045)]、IUD嵌顿[77.078(40.631,146.220)]、子宫后位[2.212(1.358,3.602)],是取器困难的独立相关因素。结论:IUD嵌顿是取出IUD困难的主要危险因素;围绝经期妇女应尽早取器;放置IUD时应选用带有尾丝、非金属单环IUD;取IUD时要注意子宫位置,尤其是前倾或后倾明显者。

Objective： To analyze the correlation factors of difficult removal of intrauterine device （IUD）. Methods： 1,960 women with IUD removal were recruited into this study, and the clinical data were analyzed according to the age of IUD removal, history of induced abortion and gynecology disease, types and keeping time of IUD, results of ultrasound examination, time of IUD placement, IUD incarceration and the relationship between uterus location and difficult removal. Results ： The age of the group with difficult removal was elder than the easy removal group. The ratios of difficult removal increased with the usage of metal and non - tail IUD, even the longer keeping time of IUD. The proportion of difficult removal was higher during peri - menopausal period. And incarceration was the critical cause leading to difficult removal. The incidences of difficult removal in uterus retroposition group were higher than anteversion or meso of uterus. Logistic regression analysis showed that ： non - tail IUD [2.985 （ 1. 555, 5. 714） ], keeping time of IUD [ 1. 042 （ 1. 008, 1. 078 ） ], time of IUD removal [ 3. 310 （2. 171, 5.045） ], IUD incarceration [77. 078 （40. 631, 146.220）] and uterus retroposition [2. 212 （1. 358, 3. 602）] were inde pendent correlation factors for difficult removal. Conclusion： IUD incarceration is the principal risk factor for difficult removal. And IUD removal should be performed as early as possible during peri - menopausal period. Non - metal and tailed IUDs are preferred when IUD placement, even more attention should be paid to the uterus location, especially the obvious anteversion and retroversion.