42例节育器异位诊疗分析

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。

Clinical analysis of 42 cases with intrauterine contraceptive device ectopic

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.