摘要
目的:探讨宫内节育器(IUD)异位的高危因素和手术处理方法。方法:选择40例IUD异位患者(IUD异位组,包括IUD部分异位至子宫肌层6例,完全异位至子宫肌层2例,异位至子宫外32例)及同期因其他妇科疾病(卵巢囊肿)住院患者中IUD位置正常的40例患者(对照组),比较两组的施术者经验、置器时间、节育器类型和施术医院级别,分析IUD异位的手术处理方法。结果:与对照组比较,IUD组患者的施术者工作年限较短、哺乳期置器者较多(P均<0.05),两组的IUD类型、施术医院级别比较差异无统计学意义(P>0.05)。所有患者均经手术取出异位IUD,8例部分或完全异位至子宫肌层患者中,6例经宫腔镜1次取出,2例先经宫腔镜取器,后因IUD嵌顿较深中转开腹取出;32例子宫外IUD异位患者中,6例经阴道后穹隆切开取出,其中1例异位于近膀胱肌层,取器过程中导致膀胱破裂,行膀胱镜检查及膀胱修补;腹腔镜取器成功14例,失败2例,其中1例因在腹腔镜下未探查到异位IUD而中转开腹取器,1例因IUD与肠管黏连严重,分离过程中致肠管破裂而中转开腹取器联合肠管修补术;剖腹探查取器12例,均1次取器成功。结论:IUD异位可能与术者经验、哺乳期置器有关;治疗应根据IUD异位类型,采取经宫腔镜、腹腔镜、阴道后穹隆切开术、开腹手术等不同的手术方式。
Objective： To evaluate the risk factors and surgical treatment for patients with ectopic intrauterine devices （IUD）. Methods： A case-control study was carried out on 40 patients with IUD translocation and 40 patients with normal location of IUD but suffered from other gynecologic diseases between 2005 and 2010 retrospectively. Results： No significant difference was revealed in age, hospital ranking, type of IUD and the duration of IUD usage between the two groups （ P 〉 0. 05 ）. Meanwhile, poor experience of operator, bad timing of IUD insertion were risk factors of ectopic IUD （P 〈 0. 05 ）. The ectopic IUD were found in muscular layer and extrauterine in 8 and 32 patients, respectively. Furthermore, hysteroscopy, posterior colpotomy, laparoscopy and laparotomy were performed on 6, 6, 14 and 14 patients for IUD removal, respectively. All ectopic IUD were successfully removed. Conclusions： The risk factors of ectopic IUD include inexperience of operator, bad timing of IUD insertion. Hysteroscopy, posterior colpotomy, laparoscopy or laparotomy should be considered according to different locations of the ectopic IUD.
出处
《新医学》
2011年第5期294-297,共4页
Journal of New Medicine
关键词
节育器异位
高危因素
腹腔镜
宫腔镜
经阴道手术
IUD translocation
Risk factors
Laparoscopy
Hysteroscopy
Transvaginal surgery
