嵌顿性宫内节育器使用米索前列醇取出难易程度的临床研究

Clinical Study on Difficulty Level of Misoprostol in Taking Out the Incarcerated Intrauterine Device

目的探讨米索前列醇在嵌顿性宫内节育器取出术中的应用效果。方法选择该院2013年1月—2017年12月收治的240例要求取出宫内节育器的妇女作为研究对象,按照数字表随机分组法将对象分为两组,对照组术前给予常规处置,观察组术前给予米索前列醇,比较两组手术时间、出血量、宫颈软化情况、疼痛分级、术中综合反应分级及手术成功率。术后随访6个月,观察两组术后出血时间、子宫内膜厚度及并发症发生率。结果观察组的手术时间为(5.7±1.2)min,术中出血量为(9.5±1.4)mL,宫颈扩张度为(5.82±0.34)mm,对照组的手术时间为(10.6±1.7)min,术中出血量为(17.8±1.9)mL,宫颈扩张度为(3.59±0.26)mm。观察组相比对照组的宫颈软化率更高,比较差异有统计学意义(χ~2=5.679、5.925、6.329、6.071;P=0.036、0.029、0.017、0.025)。观察组疼痛分级分别为:轻度74.2%(89/120)、中度20.8%(25/120)、重度5.0%(6/120);对照组为:轻度43.3%(52/120)、中度40.0%(48/120)、重度16.7%(20/120),比较差异有统计学意义(χ~2=5.574、5.985、6.276;P=0.038、0.030、0.022)。观察组术中综合反应分级为:轻度90.0%(108/120)、中度9.2%(11/120)、重度0.8%(1/120);对照组为:轻度74.2%(89/120)、中度18.3%(22/120)、重度7.5%(9/120),比较差异有统计学意义(χ~2=5.392、5.735、6.106;P=0.043、0.035、0.024)。观察组手术成功率为:顺利90.0%(108/120)、困难10.0%(12/120)、失败0%(0/120);对照组为:60.0%(72/120)、35.8%(43/120)、4.2%(5/120),比较差异有统计学意义(χ~2=5.814、6.051、5.337;P=0.034、0.028、0.044)。观察组子宫内膜厚度为(3.57±0.19)mm,对照组为(3.02±0.17)mm,比较差异有统计学意义(t=23.6317、P=0.0000)。观察组术后出血超过3 d为2.5%(3/120)、对照组为11.7%(14/120),比较差异有统计学意义(χ~2=7.6602、P=0.0056)。结论米索前列醇能有效软化和扩张宫颈,有利于提高嵌顿性宫内节育器取出成功率,值得临床应用探索。

Objective To study the application effect of difficulty level of misoprostol in taking out the incarcerated intrauterine device. Methods 240 cases of women with incarcerated intrauterine device required to taken out admitted and treated in our hospital from January 2013 to December 2017 were selected and randomly divided into two groups,the control group used the routine treatment before surgery, while the observation group were treated with misoprostol before surgery, and the operation time, bleeding amount, cervix softening, pain classification, intraoperative comprehensive reaction classification and successful rate of operation were compared between the two groups, and the postoperative bleeding time, endometrium thickness and incidence rate of complications of the two groups were observed in 6 months after surgery. Results The operation time, intraoperative bleeding amount, and cervical dilatation degree in the observation group and in the control group were respectively（5.7±1.2）min,（9.5±1.4）mL,（5.82±0.34）mm and（10.6±1.7）min,（17.8±1.9）mL,（3.59±0.26）mm, and the differences between groups were statistically significant（χ~2=5.679, 5.925,6.329, 6.071; P =0.036, 0.029, 0.017, 0.025）, and the pain classification in the observation group and in the control group, mild 74.2%（89/120）, moderate 20.8%（25/120）, severe 5.0%（6/120）; mild 43.3%（52/120）, moderate 40.0%（48/120）, severe 16.7%（20/120）, and the differences between the two groups were statistically significant（χ~2=5.574, 5.985,6.276; P =0.038, 0.030, 0.022）, and the postoperative comprehensive reaction classification in the observation group and in the control group： mild 90.0%（108/120）, moderate 9.2%（11/120）, severe 0.8%（1/120）; mild 74.2%（89/120）, moderate 18.3%（22/120） and severe 7.5%（9/120）, and the differences were statistically significant（ χ~2=5.392, 5.735, 6.106;P=0.043, 0.035, 0.024）, and the operative successful rate in the observation group and in the control group： smooth90.0%（108/120）, difficulty 10.0%（12/120）, failure 0%（0/120）; 60.0%（72/120）, 35.8%（43/120）, 4.2%（5/120）, and the differences were statistically significant（ χ~2=5.814, 6.051, 5.337; P=0.034, 0.028, 0.044）, and the endometrium thicknessin the observation group and in the control group was respectively（3.57±0.19）mm and（3.02±0.17）mm, and the differences were statistically significant（t=23.6317, P=0.0000）, and the intraoperative bleeding more than 3 d in the observation group and in the control group was respectively 2.5%（3/120） and 11.7%（14/120）, and the differences were statistically significant（ χ~2=7.6602, P=0.0056）. Conclusion The misoprostol can effectively soften and dilate the cervix,which is conductive to improving the removal successful rate of incarcerated intrauterine device, which is clinical application and exploration.