宫腔镜及腹腔镜在宫内节育器异位诊治中的应用

Application of Hysteoscopy and Laparoscopy in the Diagnosis and Treatment of IUD Transmigration

对我院 1991年至 1998年住院 13例宫内节育器 (Intrauterine Contraceptive Device ,IUD)异位的分析发现 ,怀疑 IU D异位的主要原因为带器妊娠取环失败 (8/ 13)。 IUD异位的诊断及定位需综合应用腹部 B超、盆腔 X线、宫腔镜及腹腔镜等检查手段。异位分类中 5例为子宫肌壁嵌顿 ,其中单纯经宫腔镜手术 3例取出完整 IU D,1例取出部分断裂的 IUD而遗留少许于子宫壁内 ,1例经开腹取出因断裂而完全嵌顿于肌壁间的 IUD;8例为腹腔异位 ,经腹腔镜取出 5例 ,2例开腹取出 ,1例放弃。宫腔镜及腹腔镜手术取出异位环 ,诊断及治疗可同时进行 ,且对患者损伤小 ,术后恢复快 ,因此在绝大多数异位 IUD的诊治中将取代开腹取环术。但对异位于腹腔伴有严重粘连的 IU D,或者合并脏器损伤时 ,开腹取环并修补脏器损伤仍为必要。

Thirteen cases of transmigration with intrauterine contraceptive device (IUD) was analyzed from 1991 to 1998. It was found that the main cause suspecting IUD transmigration was failure of removal of IUD with pregnancy in 8 patients out of 13 cases. The diagnosis and localization of transmigration IUD must combine various methods such as abdominal sonography, pelvic x ray, hysteroscopy and laparoscopy. In 5 cases of IUD embedding myometrium, complete IUD in 3 cases and uncomplete IUD in 1 case were removed under the hysteroscopy, and the IUD in the remaining 1 case was removed by laparotomy. The rest 8 cases were diagnosed having IUD transmigrating into abdominal cavity. The IUD was removed under the laparoscopy in 5 cases and by laparotomy in 2 cases. One patient gave up. There are advantages of less damage to and quick recovery for the patients in IUD removal under the hysteroscopy and laparoscopy. Laparotomy would be replaced by laparoscopy in most of cases of IUD transmigrating into abdominal cavity. But if there are damage to organs in pelvic cavity or IUD adhering to organ severely, it is necessary to use laparotomy for removing IUD and repairing the lesions of the organs.