宫腔镜下取嵌顿环的优势  

Advantage of Hysteroscopy in Taking out the Incarcerated Intrauterine Device

作　　者：邱学燕 任亚娟[1] 陈淑涛[1] 牟菁[1] 林青[1] QIU Xue-yan;REN Yajuan;CHEN Shu-tao;MOU Jing;LIN Qing(Department of Gynecology,Sichuan Integrative Medicine Hospital,Chengdu 610041,China)

机构地区：[1]四川省中西医结合医院妇科,成都610041

出　　处：《国际生殖健康／计划生育杂志》2018年第2期119-121,176,共4页Journal of International Reproductive Health/Family Planning

摘　　要：目的:比较宫腔镜下取嵌顿环和B型超声(B超)定位下取嵌顿环的疗效及安全性。方法:选取2013年1月—2017年3月于四川省中西医结合医院因常规宫内节育器(IUD)取出失败的患者87例,诊断为IUD嵌顿。采用随机数字表法分为观察组(45例)和对照组(42例),观察组采用宫腔镜下IUD取出术,对照组采用B超定位下IUD取出术。记录2组患者的手术时间、术中出血量、一次取出IUD成功率、住院时间和治疗费用。术后随访1个月,详细记录腰痛、下腹痛发生情况和阴道出血情况。结果:观察组一次取出IUD成功率高于对照组,差异有统计学意义(χ2=7.112,P=0.000);手术时间较对照组缩短,术中出血量也少于对照组,差异均有统计学意义(χ2分别为4.322和6.083,均P<0.05)。术后随访1个月,2组均未发生子宫穿孔、宫腔粘连、感染等手术并发症。观察组患者术后腰痛、下腹痛为0~Ⅰ级及阴道出血时间≤1 d或无出血者所占比例均高于对照组,差异有统计学意义(均P<0.05)。2组患者住院时间比较,差异无统计学意义[(2.24±0.63)d vs.(2.08±0.54)d,t=0.003,P=0.976];观察组治疗费用高于对照组,差异有统计学意义[(2 231.28±256.90)元vs.(1 712.14±156.82)元,t=6.117,P=0.007]。结论:宫腔镜下取嵌顿环手术时间短,术中出血量较少,一次手术成功率高,安全性高,但费用相对较高,可作为常规IUD取出失败后的补救措施,值得临床推广。Objective:To compare the efficiency and safety of two methods taking out the incarcerated intrauterine device(IUD):hysteroscopy and B-mode ultrasound.Methods:A total of 87 patients underwent unsuccessfully the conventional removal of IUD were diagnosed as the incarcerated IUD from January 2013 to March 2017.Based on a random table,the 45 cases were treated with hysteroscopy to take out their IUD as the observation group,and 42 cases with B-mode ultrasound to take out IUD as the control group.The operation time,intraoperative blood loss,the success rate of taking out IUD at once,hospital stays and expense were compared between the two groups.The incidences of lumbar pain and low-abdominal pain and vaginal bleeding in 1 month of following up were also compared.Results:The success rate of IUD removal at once in the observation group was significantly higher than that in the control group(χ2=7.112,P=0.000).The operation time and the bleeding amount in the observation group were significantly less than those in the control group(χ2=4.322 and 6.083,all P<0.05).There were no complications such as uterine perforation,intrauterine adhesions and infection in one month of following up in the two groups.The incidences of 0~Ⅰgrade of lumbar pain and low-abdominal pain,and≤1 day of vaginal bleeding or no bleeding,in observation group were significantly higher than those in the control group(all P<0.05).There was no significant difference in hospital stays between the two groups[(2.24±0.63)d vs.(2.08±0.54)d,t=0.003,P=0.976].However,the treatment cost in the observation group was significantly higher than that in the control group[(2 231.28±256.90)Yuan vs.(1 712.14±156.82)Yuan,t=6.117,P=0.007].Conclusions:Taking out the incarcerated IUD under hysteroscopy can be recommended due to the shorter operation time,less blood loss,higher success rate and higher safety,although the relatively higher treatment cost,when compared with the method under B ultrasound.

关 键 词：宫内避孕器 宫腔镜 宫腔镜检查 B超定位 超声检查 宫内避孕器排出 优势 

分 类 号：R713[医药卫生—妇产科学]