论文部分内容阅读
目的:探讨用宫腔镜B超监视取器术对困难性器取的价值。方法:回顾性分析5613例取器手术的临床资料。结果:①门诊取器者共5308例,取器失败13例(0.24%),绝经2年后,取器失败率0.54%,显著高于绝经前的0.13%;②住院困难性取器305例,经宫腔镜检查或术中联合B超监视行取器手术,一次性取器成功301例,术后诊断为IUD嵌顿137例、变形41例、碎片残留20例、下移11例、其他因素96例;③IUD嵌顿137例(2.44%)中人工流产术后即刻放置者嵌顿率(3.33%)显著高于常规月经干净后3～7d放置者(2.09%),V型IUD、T型IUD和圆型IUD等的嵌顿率分别为:3.93%、2.66%和1.47%,V型IUD嵌顿率显著升高;④造成困难性取器的其他因素还包括:IUD变形、宫颈扩张或暴露困难、宫颈管粘连或封闭等,其次是前次取器手术造成子宫不全穿孔即假道形成、子宫肌瘤和宫腔粘连等。结论:宫腔镜B超监视取器术对困难性取器是安全有效的手术方式;人工流产术后即刻放置IUD者其嵌顿发生率显著高于月经干净后放置者。
Objective: To investigate the value of hysteroscopic B-ultrasound surveillance of difficult devices. Methods: A retrospective analysis of 5613 cases of surgical operation of the clinical data. Results: (1) There were 5308 outpatients, 13 cases (0.24%) failed to take the device, and 0.54% failed to take the device after 2 years of menopause, which was significantly higher than that of premenopausal patients (0.13%); , Hysteroscopy or intraoperative ultrasound combined with B-line monitoring operation, 301 cases of successful one-off access, postoperative diagnosis of IUD incarcerated in 137 cases, 41 cases of deformation, residual debris in 20 cases, down 11 cases, 96 cases of other factors; ③ IUD incarceration in 137 cases (2.44%) of induced abortion immediately after incarceration (3.33%) was significantly higher than the conventional menstrual clean 3 ~ 7d placed (2.09%), V IUD, The incarceration rates of T-shaped IUD and circular IUD were 3.93%, 2.66% and 1.47%, respectively, and the V-shaped IUD incarceration rate was significantly increased. Other factors that caused the difficulty in collecting devices included IUD deformation, cervical Expansion or exposure difficulties, adhesions or closure of the cervical canal, etc., followed by surgery before the second uterine imperforation caused by the formation of prosthesis, uterine fibroids and intrauterine adhesions. Conclusions: The hysteroscopic B-ultrasound surveillance is a safe and effective surgical method for difficult patients. The incidence of incarceration immediately after artificial abortion is significantly higher than that after menstruation.