取器困难患者307例临床分析

Clinical analysis of 307 patients with difficulty in IUD removal

目的探讨因宫内节育器(intrauterine device,IUD)异位、残留等取器困难需要住院取出IUD的患者临床特点及诊治方案。方法回顾性分析中国医科大学附属盛京医院2015年1月1日至2019年10月1日期间因IUD异常需要住院取出IUD的患者病史及诊断治疗经过,包括年龄、月经情况、术前检查、手术经过等。结果IUD取出困难患者共307例,其中IUD异位291例,IUO残留16例。未绝经患者异位的IUD类型以爱母环为主,绝经后患者异位的IUD类型以圆形环为主。IUD异位的患者应用宫腔镜和(或)腹腔镜或开腹手术均成功取器。IUD残留的患者共16例,成功取出14例,其余2例合并宫腔积脓,患者年龄较大行宫腔积脓引流术,宫腔镜未探及残留IUD。结论大部分异位于子宫肌层的IUD经宫腔镜和(或)腹腔镜成功取出,异位于子宫外的IUD大部分经腹腔镜成功取出。

Objective Explore the clinical characteristics and diagnosis and treatment of patients who need to be hospitalized to remove IUD due to difficulties in removing the intrauterine device(IUD)and residual.Methods A retrospective analysis of the medical history,diagnosis and treatment of patients in Shengjing Hospital Affiliated to China Medical University from January 1,2015 to October 1,2019 due to abnormal IUDs requiring IUD removal,including age,menstruation,preoperative examination,the operation,etc.Results There were 307 patients with difficulty in IUD extraction,including 291 patients with ectopic IUD and 16 patients with residual IUD.The ectopic IUD type of premenopausal patients was mainly MCu IUD,and the ectopic IUD type of postmenopausal patients was mainly circular ring.In patients with ectopic IUD,hysteroscopy and/or laparoscopy or laparotomy were successfully removed.A total of 16 patients with residual IUD,14 cases were successfully removed,and the remaining 2 cases were complicated with uterine empyema.The old patients underwent empyema drainage,and the hysteroscope did not detect residual IUD.Conclusion Most of the IUDs that are located in the myometrium are successfully removed by hysteroscopy and/or laparoscopy,and most of the IUDs that are located outside the uterus are successfully removed by laparoscopy.