上海市宫内节育器取出术现状的调查分析  

Situation on the Removal of Intrauterine Device in Shanghai

作　　者：康建中[1] 肖志琴[1] 黄咏梅[1] 刘晓瑷[1] 

机构地区：[1]上海交通大学医学院国际和平妇幼保健院上海市计划生育技术指导所,上海200030

出　　处：《实用妇产科杂志》2011年第2期127-130,共4页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:调查上海市宫内节育器(IUD)取出的现状和方法,探讨手术并发症的原因及安全取出IUD的措施。方法:对上海市87所医院2001～2007年期间所有IUD取出术病例进行回顾性调查,内容包括手术方式、手术地点及是否施行静脉麻醉手术等。对严重并发症进行个案调查。结果:2001～2007年常规IUD取出术数量稳步上升,维持在每年60000～100000例。二级综合医院、三级综合医院和妇幼保健院手术分布为37.61%、16.41%和45.98%。与2001年比较,2007年宫腔镜IUD取出术住院数量上升158.47%,静脉麻醉宫腔镜IUD取出手术上升124.47%。常规IUD取出术和宫腔镜IUD取出术中,严重并发症的发生率各为2.99/10万和36.00/10万。常规IUD取出术中17例严重并发症为脏器损伤14例,感染引起再次开腹手术3例。宫腔镜IUD取出术的严重手术并发症为死亡病例4例。结论:随着近年来IUD取出术逐年上升,宫腔镜手术有助于困难IUD的取出。建立宫腔镜操作规范,包括配置、抢救设备和有资质的医护人员是非常必要的。Objective：To explore the possible causes of complications that happened at removal of intrauterine devices （IUD） as well as to find measures to improve the safety of the surgery based on analysis of the current situation and methods of IUD removal in Shanghai. Methods：A retrospective survey was conducted on all IUD removal cases at 87 hospitals in Shanghai from January 2001 to December 2007,including the method and place of IUD removal and with or without intravenous anaesthesia. Further investigations were performed on cases with severe complications. Results：The amount of regular IUD removal was increased from 2001 to 2007 ranging from 60000 to 100000 per year. Among which,37.61 % were carried in the secondary general hospitals,16.41% were in the tertiary general hospitals,and 45.98% were in maternal and child hospital （MCH）,respectively. Compared with that in 2001,the number of hospitalized hysteroscopic removal of IUD was increased 158.47% in 2007,and the number of hysteroscopic removal of an IUD with intravenous anaesthesia was increased 124.47%. The incidence of severe complications of regular removal of IUD was 2.99/100000,while that of hysteroscopic removal was 36.00/100000. The severe complications of regular removal of IUD included viscus injury （14 cases） and infection-induced laparotomy （3 cases）. The severe complications of hysteroscopic removal of IUD were death （4 cases）. Conclusions：The number of IUD removal is increasing in recent years. The use of hysteroscope is proved helpful in difficult situations. It is right time to formulate a guideline for the hysteroscopic removal of IUD,which includes the first-aid supplies and the evaluation of the qualification of the operators.

关 键 词：宫内节育器 宫腔镜 静脉麻醉 并发症 死亡 

分 类 号：R169.4[医药卫生—公共卫生与预防医学]