宫腔镜联合超声在宫内节育器取出失败中的应用价值

The clinical value of hysteroscopy combined with sonogrophy in removing IUD in difficult cases

目的分析B超联合宫腔镜在宫内节育器取出失败中的应用价值。方法常规宫内节育器取出困难患者,先在B超监视下行宫腔镜检查,对IUD准确定位,分析IUD与子宫肌层关系后,在超声监护下经阴道取器或选择经腹或腹腔镜途径取器。结果 13例子宫正常,IUD位置正常;29例IUD部分或全部异位;8例子宫内膜病变合并IUD异位;1例子宫极度后倾合并子宫陈旧性穿孔。术前B超25例判断正确,9例IUD断端与子宫内膜及浅肌层关系判断错误,3例子宫内膜息肉未发现,1例子宫极度后倾曲合并子宫陈旧性穿孔未提示。44例镜下取器成功,5例腹腔镜取出,2例IUD开腹取出。结论 B超在判断IUD断端与子宫内膜及浅肌层关系以及子宫腔病变时会有一定误差;B超联合宫腔镜检查不仅可以明确IUD定位、定形,选择恰当的取器方法,而且可提高取器的安全性和成功率。

Objective To evaluate the clinical value of removing IUD by hysteroscopy combined with sonogrophy in difficult cases.Methods After the failure of routine way,the IUD was identified first through B ultrasound only,then the IUD was identified again by hysteroscopy combined with sonogrophy.Removing the IUD by vaginal,abdomen or laparoscope after analyze the relation of the IUD and uterine muscular layer.Results In the all 51 cases,13 cases were normal;29 cases were ectopic IUDs;8 cases were endometrial disease combined with ectopic IUDs.1 case was septate uterus with serious uterine retroversion.The results of ultrasonic examination were correct only 25 cases,other 9 cases were misjudged the relationship of IUD residues and endometriumor superficial tunica muscular layer.8 cases with polypi were not detected.1 case with serious uterine retroversion were not found.The IUDs in 44 cases were successfully removed under the guide of hysteroscopy combined with sonogrophy,5 cases of IUDs were successfully removed by laparoscope;2 IUDs were removed by laparotomy.Conclusion Ultrasonic examination is a safe and reliable method to confirm the position of IUD,but it would be misjudging the relationship of IUD residue,endometrium or superficial tunica muscular layer,and other pathological changes in uterine cavity.The combination of hysteroscopy combined with sonogrophy can help us to define the precise location and figuration of the IUD and to choose a proper method to remove the IUD.