宫腔镜处理绝经后妇女难取宫内节育器临床分析

Clinical analysis of hysteroscopy in the treatment of postmenopausal women with difficult removal of intrauterine contraceptive device

目的探讨宫腔镜在绝经后妇女宫内节育器(IUD)取出困难情况下的临床应用。方法收集2017年1月至2019年12月首都医科大学附属北京同仁医院收治的用常规方法取IUD失败而行宫腔镜取环的50例绝经后妇女的临床资料行回顾性分析。观察IUD宫腔镜取环结果,术后随访1个月有无不适,分析IUD的分类及造成取环困难的情况及前期取环失败原因。结果全身麻醉下用宫腔镜成功取出IUD 49例,成功率为98.0%(49/50)。无子宫穿孔、脏器损伤、阴道大出血、水中毒、栓塞、休克、感染等并发症发生。50例妇女中圆环28例(56.0%)、T环16例(32.0%)、其他类型6例(12%),圆环多见。圆环中嵌顿发生率高,16例(57.1%)。IUD形态或位置异常(包括嵌顿、断裂、残留、下移)共45例,占90.0%,为常规方法取环失败主要原因。结论宫腔镜直视下处理绝经后妇女难取IUD,操作简便,相对安全,环取出成功率高。

Objective To explore the clinical application of hysteroscopy in the treatment of postmenopausal women with difficult removal of intrauterine contraceptive device(IUD).Methods The clinical data of 50 post⁃menopausal women who failed to take IUD by conventional methods and underwent hysteroscopic ring removal in Beijing Tongren Hospital,Capital Medical University from January 2017 to December 2019 were analyzed retrospectively.The results of IUD hysteroscopic ring removal were observed and patients were followed⁃up for 1 month to observe adverse reactions.The classification of IUD,the difficulties in ring taking and the causes of early ring taking failure were analyzed.Results There were 49 cases of IUD successfully removing with hysteroscopy under general anesthesia,and the success rate was 98.0%(49/50).No complications such as uterine perforation,organ injury,massive vaginal bleeding,water poisoning,embolism,shock and infection occurred.Among the 50 women,28 cases(56.0%)of ring,16 cases(32.0%)of T⁃ring and 6 cases(12.0%)of other types were found.The incidence of incarceration in the ring was high,with 16 cases(57.1%).There were 45 cases of abnormal IUD shape or position(including incarceration,fracture,residue and downward movement),accounting for 90.0%,and those were the main reasons for the failure of conventional ring removal.Conclusion The hysteroscopy for the difficult removal of IUD is simple and relatively safe,and the success rate of removal is high.