困难取器相关因素临床分析

Clinical correlation factors analysis of difficult removal of intrauterine device

探讨影响宫内节育器(IUD)取出困难的相关因素。方法:分析来自不同省份22个县级计划生育服务机构、5所三甲医院、以及2个省市级计划生育服务机构9562例IUD取出者的临床资料,调查IUD使用情况及实施操作医师情况与发生取器困难的关系。结果:取器困难发生率为5.7%。Logistic回归分析表明绝经状态(OR=1.994,95%CI=1.54~2.59)、剖宫产史(OR=1.440,95%CI=1.07~1.94)、宫颈手术史(OR=1.444,95%CI=1.16~1.80)、子宫大小异常(OR=1.449,95%CI=1.08~1.95),低级别医疗机构(OR=2.342,95%CI=1.59~3.45),以及医师工作年限短(<5年)(OR=1.364,95%CI=1.03~1.80)是发生取器是发生取器困难的危险因素。而操作医师学历硕士及以上学历(OR=0.300,95%CI=0.10~0.95),取器时子宫为前位和中位,IUD取出者年轻,以及IUD使用时间短时间是发生取器困难的保护因素。结论:困难取器是多方面因素所致,通过详细询问病史,做好术前查体及相关辅助检查,对高危取器手术应做好术前评估,并由经验丰富的医生完成IUD取出手术,可以减少取器困难和手术并发症的发生,保护女性生殖健康水平。

Objective:To analyze the correlation factors of difficult removal of intrauterine device(IUD).Methods:Based on the clinical data of 9562 women who had experienced IUD removal From 22 county-level family planning service institutions,2 provincial-level family planning service institutions,and 5 grade-three general hospitals of different provinces,the relationship between the situation of IUD used or the level of providers who performed the operation of IUD removal and the difficulty of IUD removal was analyzed.Results:The incidence of difficulties for the IUD removal is 5.7%,The Logistic regression analysis showed that the menopause status(OR 1.994,95%CI=1.54~2.59),a history of cesarean section(OR=1.440,95%CI=1.07~1.94),the cervix uteri surgery(OR=1.444,95%CI=1.16~1.80),abnormal uterine size(OR=1.449,95%CI=1.08~1.95),and low level of medical institution of providers worked(OR=2.342,95%CI=1.59~3.45),<5 working years of provider(OR=1.364,95%CI=1.03~1.80)were risk factors for the difficulty of IUD removal.And the providers's education level equal to or over medical master(OR=0.300,95%CI=0.10~0.95),anterior or median uterus,the younger age of women,and the shorter duration of IUD used were protective factors for the difficulty of IUD removal.