宫腔镜在绝经后困难取宫内节育器中的临床应用——附121例临床分析

Hysteroscopic management of intrauterine devices(IUD) with difficult removal in postmenopausal women:a retrospective study with 121 cases

目的：探讨绝经后宫内节育器（IuD）取出困难的原因及宫腔镜在绝经后困难取IUD中的临床应用价值。方法：收集121例绝经后IUD困难取出妇女宫腔镜下取器的资料进行分析。结果：121例妇女在宫腔镜下均取器成功。术前应用超声诊断IUD嵌顿符合率为60％，灵敏度为62％，阳性似然比为1．24。另外，绝经≤1年组妇女IUD嵌顿数明显低于绝经1~2年，及〉2年组（P〈0．05）。置器年限≤10年组IUD嵌顿数明显低于置器10~20年7＆〉20年组（p〈0．05）。结论：IUD嵌顿是绝经后取器困难的主要原因。宫腔镜能准确了解IUD宫腔内情况，很大程度上能提高取器戍功率，降低手术风险，是一种安全、有效的取器方法。

Objective： To investigate the reasons that are responsible for difficult removal of intrauterine device （IUD） and the efficacy of hysteroscopy in its management in postmenopausal women. Methods： A retro- spective study was carried out with 121 postmenopausal patients who experienced a difficult removal of an IUD, and underwent hysteroscopy for the removal of an IUD. Analysis of the IUD removals database retrieving data concerning hysteroscopies was performed for occult IUD removal in postmenopausal women. Results： All the 121 patients （100%） had successful removal of IUD. The diagnostic coincidence rates, sensitivity and positive likelihood ratio of preoperative ultrasonography were high （60%, 62% and 1.24, respectively） for diagnosis of type of IUD incarceration. In addition, the percentage of IUD incarceration was positively associated with a longer menopausal time span （MTS） or duration of IUD insertion （DII）： significantly higher IUD incarceration rate was observed in the subgroup with a MTS ≤ 1 year than those with a MTS〉I year （P〈0.05）, or in the subgroup with a DII ≤10 years than those with a DII〉10 years （P〈0.05）. Conclusion： Difficult removal was associated with incarceration and fracture of IUD, intrauterine adhesion, neoplasm in uterine cavity, as well as vaginal and cervical atrophy. Hysteroscopy is effective and safe in removing IUD.