放置宫内节育器后出血的宫腔镜及子宫内膜组织病理学检查

The Hysteroscopic and Endometrial Pathological Examination for the Bleeding Patients Using Intrauterine Devices

分析宫腔镜及子宫内膜组织病理学检查在查找置入宫内节育器（ＩＵＤ） 后出血原因中的作用。应用电视宫腔镜对１２０ 例ＩＵＤ后出血病例进行镜检， 并对其中１００ 例行诊刮及子宫内膜组织病理检查。结果： 经宫腔镜发现子宫内膜出血１０５ 例次 （６９．５％ ）， 内膜息肉及息肉样增生２９ 例次 （１９．２％ ）， 子宫粘连１１ 例次 （７．３％ ）， 子宫肌瘤６ 例次（４．０％ ）， ＩＵＤ形态与位置异常２９例次（２４．２％ ）。子宫内膜组织病理学检查１００ 例， 其中增生期及分泌期子宫内膜５２例（５２．０％ ）， 子宫内膜增生过长４４ 例（４４．０％ ）。结论： ＩＵＤ后出血的主要原因为ＩＵＤ对子宫内膜局部的机械性压迫，引起内膜充血、坏死及出血； ＩＵＤ的位置、大小与宫腔不相匹配； 合并子宫或子宫内膜病变如子宫内膜增生过长。宫腔镜结合子宫内膜组织病理检查可较准确地诊断ＩＵＤ后出血的原因。

To analyze the role of hysteroscopic and endometrial diagnostic curettage in finding the causes of bleeding after using intrauterine devices (IUD), 120 patients with bleeding following use of IUD underwent hysteroscopic examination. Among these cases, 100 were curetted and subjected to endometrial pathological examination. The results showed that 105 case times (69 5%) were hysteroscopically found having endometrial affection, 29(19 2%) having endometrial polypus and polypoid hyperplasia, 11(7 3%) having metrosynizesis, 6(4 0%) having metrofibroma. It was also observed that 29 casetimes (24 2%) revealed abnormal shape and location of IUD. Among the 100 cases undergoing pathological examination, endometria in proliferative and secretory phases were observed in 52 (52 0%), endometrial hyperplasia in 44(44 0%). It was concluded that the main causes of bleeding after using IUD might include the compression on the endometrium by IUD which induces the endometrium congestion, necrosis and bleeding, wrong location and mismatched size of the IUD, and the associated pathological lesions of uterine or endometrium such as endometrial hyperplasia. The combination of hysteroscopy and endometrial pathological examination could accurately diagnose the causes of bleeding following use of IUD.