宫内节育器取出5613例临床分析

Clinical Analysis of IUD Extraction in 5613 Cases

目的:探讨用宫腔镜B超监视取器术对困难性器取的价值。方法:回顾性分析5613例取器手术的临床资料。结果:①门诊取器者共5308例,取器失败13例(0.24%),绝经2年后,取器失败率0.54%,显著高于绝经前的0.13%;②住院困难性取器305例,经宫腔镜检查或术中联合B超监视行取器手术,一次性取器成功301例,术后诊断为IUD嵌顿137例、变形41例、碎片残留20例、下移11例、其他因素96例;③IUD嵌顿137例(2.44%)中人工流产术后即刻放置者嵌顿率(3.33%)显著高于常规月经干净后3～7d放置者(2.09%),V型IUD、T型IUD和圆型IUD等的嵌顿率分别为:3.93%、2.66%和1.47%,V型IUD嵌顿率显著升高;④造成困难性取器的其他因素还包括:IUD变形、宫颈扩张或暴露困难、宫颈管粘连或封闭等,其次是前次取器手术造成子宫不全穿孔即假道形成、子宫肌瘤和宫腔粘连等。结论:宫腔镜B超监视取器术对困难性取器是安全有效的手术方式;人工流产术后即刻放置IUD者其嵌顿发生率显著高于月经干净后放置者。

Objective： To study the effect of combined use of hysteroscopy and ultrasonography in difficulty extracting IUD cases. Methods： 1UD extracting operations of 5 613 patients were reviewed. Results： 1） A total of 5 308 patients had their IUD removed by regular clinical operations. Thirteen cases were reported failure, which was 0.24% of total cases. Two years later after menopause, the failure rate of extracting IUD was 0.54%, it was significantly higher than that before menopause （0.13 %）. 2） Three hundreds and five patients experienced hospitalized treatment for removal. With hysteroscopic or ultrasonic guidance, 301 cases were successfully managed. The post-operation diagnosis demon- strated various causes of difficulty removal. There were 137 female having IUD embeded, 41 cases were reported as IUD distortion, while 20 cases were fragment remaining and 11 were IUD dislodgement. The remaining 96 cases were caused by other reasons. 3） Among 137 cases （2.44%） with IUD embedment, the embednent rates were 2.09% and 3.33% respectively for IUD insertion during 3-7 d after menstruation or just after abortion, which had distinctly statistical difference. However, different shapes of IUD were identified as an apparent contribution to the incarcerations. The embedment risks for V-shaped 1UD, T-shaped and Circle were 3.93%, 2.66% and 1.47%, respectively. It＇s pretty safe to say that V-shaped IUD tends to be easier to get embeding than others. 4） Other causes of difficulty removal were including IUD distortion, cervical dilation/exposure being ambiguous, cervix adhesion/closure, false passage formed by pervious operation, uterine leiomyomas and pelvic adhesion. Conclusion： Combined use of hysteroscopy and ultrasonog- raphy is an effective approach to manage the difficulty extraction of IUDs. The embedment rate of patients who placed IUD immediately after abortion was significantly higher than those placed after the menstruation, it is appropriate to select other methods of contraception.