中国医药科学
中國醫藥科學
중국의약과학
CHINA MEDICINE AND PHARMACY
2014年
16期
194-196,210
,共4页
宫内节育器%异位%诊断%治疗
宮內節育器%異位%診斷%治療
궁내절육기%이위%진단%치료
Intrauterine contraceptive device%Ectopic%Diagnosis%Treatment
目的：探讨宫内节育器异位的原因、诊断方法，分析IUD异位的危险因素、处理方法。方法回顾性分析42例节育器异位的临床资料。结果爱母环占61.90%（26/42），O形环占28.57%（12/42），T环形占4.76%（21/42），吉妮环占4.76%（2/42）；爱母环发生异位的机率明显高于其它类型节育器；位于子宫肌层内30例，穿破浆膜层4例；子宫外异位：位于盆腔内6例，阔韧带后叶3例；爱母环的一条金属臂穿入乙状结肠1例，穿入宫旁1例，1例位于右上腹大网膜内，1例位于肠管表面。取器方式利用宫腔镜、腹腔镜、宫腹腔镜联合、膀胱镜及开腹等方式，均成功。有随访记录的14例占33.4%，其中，术后1+月随访3例占7.1%，1年内随访者有12例占21.4%，3年内随访者2例占4.8%，无随访者28例占66.7%。节育环异位穿孔率无随访者高于有随访记录者。在节育器异位患者中，上环后有再次妊娠15例占35.7%。结论选择合适的节育器，适宜的安环时间可减少节育器异位的发生。充分术前评估，选择适宜的手术方式、及时、合理转换术式是取环成功的关键。
目的：探討宮內節育器異位的原因、診斷方法，分析IUD異位的危險因素、處理方法。方法迴顧性分析42例節育器異位的臨床資料。結果愛母環佔61.90%（26/42），O形環佔28.57%（12/42），T環形佔4.76%（21/42），吉妮環佔4.76%（2/42）；愛母環髮生異位的機率明顯高于其它類型節育器；位于子宮肌層內30例，穿破漿膜層4例；子宮外異位：位于盆腔內6例，闊韌帶後葉3例；愛母環的一條金屬臂穿入乙狀結腸1例，穿入宮徬1例，1例位于右上腹大網膜內，1例位于腸管錶麵。取器方式利用宮腔鏡、腹腔鏡、宮腹腔鏡聯閤、膀胱鏡及開腹等方式，均成功。有隨訪記錄的14例佔33.4%，其中，術後1+月隨訪3例佔7.1%，1年內隨訪者有12例佔21.4%，3年內隨訪者2例佔4.8%，無隨訪者28例佔66.7%。節育環異位穿孔率無隨訪者高于有隨訪記錄者。在節育器異位患者中，上環後有再次妊娠15例佔35.7%。結論選擇閤適的節育器，適宜的安環時間可減少節育器異位的髮生。充分術前評估，選擇適宜的手術方式、及時、閤理轉換術式是取環成功的關鍵。
목적：탐토궁내절육기이위적원인、진단방법，분석IUD이위적위험인소、처리방법。방법회고성분석42례절육기이위적림상자료。결과애모배점61.90%（26/42），O형배점28.57%（12/42），T배형점4.76%（21/42），길니배점4.76%（2/42）；애모배발생이위적궤솔명현고우기타류형절육기；위우자궁기층내30례，천파장막층4례；자궁외이위：위우분강내6례，활인대후협3례；애모배적일조금속비천입을상결장1례，천입궁방1례，1례위우우상복대망막내，1례위우장관표면。취기방식이용궁강경、복강경、궁복강경연합、방광경급개복등방식，균성공。유수방기록적14례점33.4%，기중，술후1+월수방3례점7.1%，1년내수방자유12례점21.4%，3년내수방자2례점4.8%，무수방자28례점66.7%。절육배이위천공솔무수방자고우유수방기록자。재절육기이위환자중，상배후유재차임신15례점35.7%。결론선택합괄적절육기，괄의적안배시간가감소절육기이위적발생。충분술전평고，선택괄의적수술방식、급시、합리전환술식시취배성공적관건。
Objective To investigate the causes and diagnostic methods of IUD ectopic, and analyze the risk factors and processing method of the IUD ectopic.Methods 42 cases clinical data of IUD ectopic were retrospectively analyzed.Results The MCU IUD was 61.90% (26/42), O ring was 28.57% (12/42), T ring was 4.76% (21/42), and Jeanne ring was 4.76% (2/42). The probability of MCU IUD ectopic was higher than other types of IUD ectopic. 30 rings were in the muscular layer of uterus, and 4 rings were perforation of serosa. Ectopic: 6 cases located in the pelvic cavity, and the posterior leaf of the broad ligament in 2 cases. MCU IUD ectopic: 1 case was a metal arm into the sigmoid colon, and 1 case was into the palace, 1 case was located in the right upper quadrant of the greater omentum, and 1 case was in the intestinal surface. Taken ring surgeries were successful through hysteroscopy, laparoscopy, hysteroscopy combined with laparoscopy, cystoscopy, and open way. 14 cases of follow-up accounted for 33.4%, including 3 cases follow-up accounted for 7.1% after operation 1+ months, 12 cases of 1 years follow-up accounted for 21.4%, 2 cases of 3 years follow-up accounted for 4.8%. 28 patients who was no follow-up accounted for 66.7%. The IUD ectopic perforation rate without follow-up was higher than that with follow-up records. In the IUD ectopic patients, 15 cases who were pregnancy accounted for 35.7%.Conclusion Fit IUD and appropriate time to ring can reduce the occurrence of ectopic IUD. It is the key to the successful that fully preoperative evaluation and choice of surgical approach, appropriate and timely conversion operation.
