宫内节育器异位原因及取出方法的临床分析

Clinical analysis of ectopic causes and removal methods of intrauterine device

目的随着宫内节育器的广泛应用,放置宫内节育器的不良反应及并发症相应增多,各种原因致节育器尾丝倒入宫腔、节育器倒头、下移、脱落、嵌顿等异位发生率增高,故对宫内节育器异位原因及不同异位情况采取不同取器方式进行分析,有利于计划生育科临床医生更好的开展工作,有利于育龄妇女更好的选择宫内节育器避孕。方法通过回顾性分析本院2013年1月~2016年12月共接诊73例节育器异位患者的病史,了解当时放置宫内节育器时期及使用时间长短,随访情况,体格检查(包括妇科检查),辅助检查(B超及X线检查),了解节育器异位情况,分析异位原因。其中68例在本院成功取出,因本院条件所限另4例异位于盆腔到上级医院行腹腔镜或开腹取出。结果哺乳期、人流术中放置节育器,放置时间过长,节育器大小不匹配,节育器种类,未能定期随访等都与节育器异位有关。结论掌握放置节育器时机,选择合适类型节育器,告知使用年限,及时治疗不良反应。节育器不同异位情况采用不同的取器方式,提高取器成功率。

Objective With the widespread application of intrauterine device(IUD), the adverse reactions and complications of IUD are increased correspondingly. There are various reasons that cause the increase of incidence of ectopic IUD such as the tail of IUD pouring into the uterine cavity, the reverse, moving down, falling off, incarceration of IUD. So we should adopt different removal methods according to different ectopic causes and ectopic situation of IUD, which not only is beneficial to the works of family planning clinic doctors but also helps childbearing women to choose more suitable IUD. Methods According to the retrospective analysis of the medical history of 73 ectopic IUD patients who visited the hospital from January 2013 to December 2016, we collected the data of those patients including the time point of placing IUD and the length of usage time, the situation of follow-up visit, physical examination(including gynecological examination), auxiliary examination(B-ultrasonography and Xray).On the basis of the data collected above, we analyze the ectopic situations and reasons of IUD respectively. Among all the cases, there are 68 patients whose IUD were taken out successfully in our hospital. Because of the limit of condition in our hospital, the rest 4 patients whose IUD were located in the pelvic cavity were asked to transfer to the superior hospital to take out the IUD by laparoscope or laparotomy. Results The ectopia of IUD is related to the placement of IUD during the lactation or abortion, the long time placement of IUD, the placement of IUD with unsuitable size or inappropriate type, the lack of regular follow-up visit. Conclusion We should insure placing IUD in the right time, choose the appropriate type of IUD, inform patients about the usage life of IUD and treat the adverse reaction in time. In order to improve the success rate of the surgery, different ectopic situation of IUD should be dealt with in different ways.