摘要
目的:探讨门诊宫腔镜技术处理节育器取出困难的临床意义.方法:分析门诊治疗的202例节育器取出困难患者的临床资料,并分析发生原因以及手术过程.结果:外院宫内节育器取出失败的病例,发生原因经宫腔镜检查主要为节育器嵌顿、断裂、残留或异位,节育器嵌顿的种类以金属圆形/三角形节育器(113例,55.9%)以及V型的爱母环(62例,30.7%)多见.5例门诊宫腔镜下取环失败,197例(97.5%)取环成功.由于子宫异常引起的困难取环27例,黏膜下肌瘤12例,宫腔/宫颈管粘连15例.手术时间分析结果提示节育器断裂残留以及既往有宫颈手术史的患者花费手术时间最长;手术出血量分析提示合并黏膜下肌瘤的患者术中出血量最多,为(32.5±3.4) mL.结论:金属圆形/三角形节育器及V型金属环更易发生宫内嵌顿;子宫异常引起的取环困难原因以黏膜下肌瘤和宫腔/宫颈管粘连多见.常规方法取出困难的宫内嵌顿节育器者用宫腔镜检查及镜下手术.
Objective:To explore the clinical significance of hysteroscopy in treating difficulty of removing intrauterine device(IUD).Methods:The clinical data of 202 cases of difficult IUD removal from January 2015 to December 2017 were retrospectively analyzed,and the causes and operation process were analyzed.Results:The 202 cases of failure of IUD removal from other hospitals was mainly caused by incarceration,rupture,residual or ectopic IUD with the diagnosis of hysteroscopy.In the 202 patients,IUD incarceration occurred chiefly in the metal ring or triangle IUD(113 cases,55.9%)and “V” type MCu IUD(62 cases,30.7%).The IUD were failed to be removed under hysteroscopy in 5 cases,while were successful in 197 cases(97.5%).There were 27 cases difficult to remove IUD due to abnormal uterus,12 cases due to submucosal myoma and 15 cases due to uterine cavity/cervical adhesion.The operation time spending in the cases with rupture and residual IUD and the history of cervical operation is the longest.The bleeding volume in patients with submucosal myoma is the most,which is 32.5±3.4 mL.Conclusion:The metal round/triangle contraceptive device and V-shape metal ring are more likely to occur intrauterine incarceration.Submucosal myoma and uterine/cervical adhesion are common cause of difficult removal of IUD caused by abnormal uterus.The hysteroscopy surgery is a better way to remove intrauterine incarcerated contraceptive device which is difficult to be taken out by routine methods.
作者
刘颖蔚
赵玲
陈星
代雪林
邓幼林
LIU Yingwei;ZHAO Ling;CHEN Xing;DAI Xuelin;DENG Youlin(Department of Gynecology,the First Affiliated Hospital of Chongqing Medical University,Chongqing,400016,China)
出处
《暨南大学学报（自然科学与医学版）》
CAS
CSCD
北大核心
2019年第1期64-70,共7页
Journal of Jinan University(Natural Science & Medicine Edition)
基金
重庆市教委科学技术研究项目(KJ1702015)
关键词
节育器取出困难
宫腔镜
Difficulty of taking out intrauterine device
hysteroscopy
