宫内节育器异位临床分析  

Clinical Analysis of Intrauterine Device Migration

作　　者：李亚冬[1] 程雷[1] 

机构地区：[1]北京军区北戴河疗养院妇产科,河北秦皇岛066100

出　　处：《临床误诊误治》2014年第8期58-60,共3页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨宫内节育器(intrauterine device,IUD)异位的发生机制及诊治要点。方法检索2002—2013年中国期刊全文数据库和中国生物医学文献数据库,筛选与IUD异位相关的文献,对入选文献的一般情况、异位IUD类型、异位部位、脏器损伤、治疗及预后情况进行总结分析。结果共筛选出与异位IUD相关的文献23篇280例,异位IUD以O型环最多(40.0%),其次为T型环(12.5%);异位于子宫肌壁间90例,子宫直肠陷凹48例,大网膜37例,腹腔25例,膀胱17例,膀胱腹膜反折处及宫颈各14例,盆腔13例,阔韧带12例,肠管7例,卵巢2例,阴道壁后穹窿1例;异位IUD致脏器损伤28例,其中膀胱损伤19例,肠梗阻4例,乙状结肠瘘2例,子宫膀胱联合损伤、腹腔异位合并尿瘘及腹腔异位合并肠穿孔、肠粘连各1例。280例均行异位IUD取出术,其中采用腔镜技术取器116例,剖腹取器87例,超声引导下经阴道取器66例,后穹窿切开取器11例;除1例拒绝中转开腹取器,余均取器成功,无其他副损伤,术后恢复良好。结论 IUD异位可致多种脏器损伤,临床应予高度重视。Objective To explore the occurring mechanism and diagnostic key points of intrauterine device （IUD） migration to reduce the incidence rate of complications. Methods Papers about IUD migration were retrieved from CNKI and CbmWin databases （ 2002-2013 ） , and general conditions, IUD types and positions, organs injuries, therapy methods and prognoses in the papers were analyzed. Results A total of 23 papers including 280 patients were selected to analyze. The main migrated IUD type was O-ring-shaped （40. 0%） followed by the T-shaped（12.5%）; Displacement positions included intramural uterine（90 cases）, rectouterine pouch （48 cases）, epiploon （37 cases）, abdominal cavity（25 cases）, urinary bladder（ 17 cases）, bladder peritoneum （14 cases）, cervix （14 cases）, pelvic cavity （13 cases）, broad ligament （12 ca-ses）, intestinal tube （7 cases）, ovary（2 cases） and vaginal posterior fornix （1 case）;28 organs injury patients by migrated IUD included 19 patients with bladder injury, 4 with intestinal obstruction, 2 with sigmoid colon fistula, 1 with combination injuries of uterus and bladder, 1 with migrated IUD in abdominal cavity combined with urinary fistula, and 1 with migrated IUD in abdominal cavity combined with intestinal perforation and ankylenteron. Migrated IUD was taken out under endoscopy in 116 cases, by laparotomy in 87 cases, ultrasound guided transvaginal operation in 66 cases, and posterior fornix incision in 11 cases;1 patient refused transferred laparotomy, and other patients recovered well after the operation without any collateral damage. Conclusion IUD migration may induce multiple organs injuries, so clinicians should pay more attention to it.

关 键 词：宫内避孕器 宫内避孕器游走 妇科外科手术 

分 类 号：R169.41[医药卫生—公共卫生与预防医学]