宫内节育器异位177例诊治分析

Diagnosis and Treatment of Intrauterine Device Displacement:an Analysis of 177 Cases

目的对宫内节育器(IUD)异位的诊治进行分析。方法回顾性分析2009年1月至2015年8月期间收治的177例IUD异位患者的临床资料。结果 177例患者中,均为含铜活性宫内节育器,以"V"型的爱母乐(90例,占50.85%)和金属圆环(72例,占40.67%)多见。孕产次比较少的年轻的育龄妇女在上环10年内较容易出现IUD异位。7例未行操作,1例取环失败,169例(99.41%)取环成功;1类IUD异位114例,2类IUD异位40例,3类IUD异位16例。宫腔镜下取环术88例;宫腹腔镜联合取环48例;腹腔镜下取环30例(术中合并结扎5例,膀胱修补3例,肠修补术3例);开腹取环4例。IUD异位无妇科合并症109例(60.89%),有妇科合并症72例中以宫腔粘连及绝经史者多见。结论严格选择上环时间,遵守手术操作规程,定期复查环位,把握最小创伤是预防和治疗宫内节育器异位的关键。推荐阴道彩超作为筛查和定位IUD的首选影像辅助手段。IUD异位务必尽快取出。Ⅰ类IUD异位建议宫腔镜下取环,直观清晰,创伤小;2类IUD,建议宫腹腔镜联合探查术,但开腹取环存在一定风险;3类异位IUD,应考虑子宫穿孔所致,腹腔镜手术是其一线治疗手段。

Objective To explore the diagnosis and treatment of intrauterine device(IUD)displacement.Methods Clinical data of 177 patients treated between January 2009 and August 2015 for IUD displacement were analyzed retrospectively.Results All these 177 patients used coppercontaining IUD.Among them,90 patients(50.85%)used V-type Mother Love IUD and 72(40.67%)used metal ring.IUD displacement easily occurred within 10 years of IUD insertion in young child-bearing age women with fewer pregnancies.A total of 169(99.41%)of these patients underwent successful IUD removal,1 underwent failed IUD removal,and 7 received no treatment.Among the 170 patients receiving treatment,type 1 IUD displacement occurred in 114,type 2 in40,and type 3 in 16.IUD removal was performed under hysteroscopy in 88 patients,under combined hysteroscopy and laparoscopy in 48 patients,and under laparoscopy in 30 patients(ligation was performed in 5,bladder repair in 3,intestinal repair in 3).Four women underwent laparotomy for IUD removal.No gynecological complications were found in 109 patients(60.89%).Most of the 72 patients with gynecological complications had the history of uterine adhesion and menopause.Conclusion The strict choice of IUD insertion time and operating procedure,regular reexamination of IUD location and assurance of minimal trauma are keys to prevent and treat IUD displacement.Transvaginal color Doppler ultrasound is preferred for screening and positioning IUD.Ectopic IUD must be removed as soon as possible.For patients with type 1 IUD displacement,the IUD should be removed under hysteroscopy due to visual clarity and small trauma.The combined hysteroscopy and laparoscopy should be performed in patients with type 2 IUD displacement.For patients with type 3 IUD displacement,laparoscopic surgery should be used as the first-line treatment because of the possible uterine perforation.