宫腔镜下处理宫内节育器取出困难53例临床分析

The clinical analysis of 53 patients with difficult in removing IUD treated under hysteroscope

目的探讨宫腔镜处理宫内节育器取出困难的优势和必要性。方法回顾性分析2005年6月～2011年7月我院收治的53例节育器取出困难患者,经宫腔镜检查发现,在宫腔镜直视下(必要时B超引导),采取直接夹取、针状电极电切粘连带,游离节育器后,以取环钩取出、环形电切环切除黏膜下肌瘤后,宫腔镜下取环钩取出,2例因宫内节育器异位入盆腔,经宫腹腔镜联合手术取出。结果 53例患者中,51例经宫腔镜处理后取出,2例经宫腹腔镜联合手术取出。结论宫内节育器取出困难的原因与节育器嵌顿子宫黏膜下层、嵌入肌层、套入黏膜下肌瘤蒂部及宫腔形态异常、宫腔粘连包裹节育器及异位有关,宫腔镜有操作方便、直观、图像放大、止血迅速、创伤小、无伤口等优点,是处理宫内节育器取出困难时的首选措施。

Objective To investigate the advantage and necessity of application of hysteroscopy in taking out IUD in difficult cases.Methods 53 patients from June 2005 to July 2011 who were difficult in removing IUD were analyzed retrospectively.It was found by hysteroscopy that using hysteroscopy（B-model ultrasound guiding,when necessary） after direct clamping,needle electrode excising adhesion belt,loop electrosurgical excision procedure exciseing myoma submucosum of uterus and freeing IUD,took ring by ring-removing device.2 cases with IUD displaced in pelvic cavity were excised by hysteroscopy-laparoscopy surgery.Results 51 cases out of 53 cases were excised by hysteroscopy,2 cases excised were by hysteroscopy-laparoscopy surgery.Conclusion The reason of difficulty in taking out IUD is related to IUD incarcerated submucosal uterine,implanted muscularis,invaginated fibroids＇s department of submuco-salmyoma of uterus and abnormally shaped uterine,intrauterine adhesion,ectopia.Hysteroscopy had advantages in easy-operating,direct viewing,image magnification,instantly bleeding stopping,minor trauma and no wound.It is the best choice of removing IUD in difficult cases.