97例宫内节育器嵌顿因素临床分析

目的 :探讨宫内节育器 (IUD)嵌顿的原因。方法 :通过对 978行IUD取出术中发现的 97例IUD嵌顿因素作了回顾性调查 ,进行了统计学处理与临床分析。结果 :(1)IUD嵌顿率随年龄的增长而增高 (P <0 .0 5 ) ;(2 )人流术中安置者嵌顿率明显高于月经净后安置者 (P <0 .0 0 5 ) ;带器时间越长 ,嵌顿率越高 (P <0 .0 0 5 ) ;IUD的嵌顿率与IUD的种类也有明显关系 ,金属类环嵌顿率最高 (P <0 .0 0 5 )。结论 :对在人流术中安环、取环时年龄偏大、安环时间较长、安置金属类圆环要求取环的妇女 ,出现嵌顿环的几率偏大 ,在取环时应尽量在B超监测下取环 ,可以增加取环成功的机会。     

超声在宫内置环术和诊断环位置异常的临床价值

目的：探讨超声在宫内置环术和诊断环位置异常的临床价值。方法：本文总结了2005年2月～2007年1月25例环位置异常的临床资料。结果：与临床符合21例，漏诊2例，胎骨残留误诊1例，对提示子宫畸形者均在超声引导下行宫内置环术，均获得成功。结论：本组对可疑腹腔环，内膜结核和胎骨残留，超声显象与环回声相似者均可行X线透视检查，可防止漏诊、误诊。本文指出超声与X线检查配合，是诊断环位置异常的最好方法。超声能显示环在宫腔及宫壁的位置，宫腔是否有环、宫外环的位置。X线能提供环在盆腔内的位置及环与耻骨联合的距离。     

B超、宫腔镜在宫内节育器取出困难中的应用

目的 分析B超和宫腔镜在宫内节育器取出困难中的应用。方法常规宫内节育器取出失败后,首先用B超进行宫内节育器(IUD)初步定位,然后在B超监视下行宫腔镜检查,再次IUD定位,并镜下取器。结果30例患者中,21例子宫正常,IUD位置正常;7例IUD部分或全部异位;1例子宫纵隔;1例子宫极度后倾曲。术前B超25例判断正确,3例IUD断端与子宫内膜及浅肌层关系判断错误,1例子宫纵隔未发现,1例子宫极度后倾曲未提示。28例镜下取器成功,2例IUD开腹取出。结论B超在判断IUD断端与子宫内膜及浅肌层关系以及子宫腔病变时会有一定误差;B超联合宫腔镜可以明确IUD定位,选择恰当的取器方法,使镜下操作更安全。     

Comparison between Two Techniques Used in Immediate Postplacental Insertion of TCu 380A Intrauterine Device：36-Month follow-up

Three hundred and eighty four women in Shanghai who delivered vaginally and chose IUD for contraception received the copper T-380A IUD inserted vaginatty within 10min after delivery of the placenta(i.e.,immediate postplacentat insertion,IPPI).Among them,98.70% were primipara.The women were randomly divided into twogroups:IUD inserted by hand and IUD insreted by ring forceps.Using Life Table Method and X^2test,expulsion and other discontinuation rates were compared at 6,12,24,and 36 months post-insertion between these two different groups.No uterine perforation,infection or prolonged period of lochia occurred in the 384 cases.Expulsions were the main reason for discontinuation.From 6 months to 36 months,the gross cumulative rates of all discontinuation events(expulsion, pregnancy,removal for bleed-ing/pain,etc.)were not statistically significantly different(P＞0.05).The results suggest that these two different insertion techniques do not significantly affect discontinuation rate in vaginal IPPI using the TCu 380A, which appears to be suitable for postpartum insertion in Chinese women.Other relevant issues,such as breast-feeding and IUD position in uterine cavity,are also analyzed and discussed in this paper.     

宫腔镜下处理宫内节育器取出困难53例临床分析

目的探讨宫腔镜处理宫内节育器取出困难的优势和必要性。方法回顾性分析2005年6月～2011年7月我院收治的53例节育器取出困难患者,经宫腔镜检查发现,在宫腔镜直视下（必要时B超引导）,采取直接夹取、针状电极电切粘连带,游离节育器后,以取环钩取出、环形电切环切除黏膜下肌瘤后,宫腔镜下取环钩取出,2例因宫内节育器异位入盆腔,经宫腹腔镜联合手术取出。结果 53例患者中,51例经宫腔镜处理后取出,2例经宫腹腔镜联合手术取出。结论宫内节育器取出困难的原因与节育器嵌顿子宫黏膜下层、嵌入肌层、套入黏膜下肌瘤蒂部及宫腔形态异常、宫腔粘连包裹节育器及异位有关,宫腔镜有操作方便、直观、图像放大、止血迅速、创伤小、无伤口等优点,是处理宫内节育器取出困难时的首选措施。     

Perforation of uterus with Saf-T-Coil

The importance of recognizing uterine penetration by an IUD is emphasized by the following case report. 4 weeks after a spontaneous delivery, a 23-year-old woman was inserted with a Saf-T-Coil; at time of insertion, she experienced marked abdominal and pelvic pain. Pain persisted, accompanied with irregular vaginal bleeding, but there were no positive somatic findings. On examination, the threads of the IUD were properly visible, but an attempt was made to remove the device on the patient's request; it was unsuccessful. A flat film of the abdomen reported that the device was within the uterine cavity, and another attempt at IUD removal under anesthesia was unsuccessful. Hysterogram revealed the device to be extrauterine and appeared to perforate the uterus, lodged in the layers of the broad ligament. By exploratory laparotomy, the coil was found protruding through the uterine wall at the junction of the internal os and corpus. The coil was removed, and the laceration of the uterus was repaired. Fortunately, only loops of the coil were adherent to the small intestine, and no injury had occurred.     

宫内节育器致子宫穿孔36例临床分析

对ＩＵＤ致子宫穿孔病例进行回顾分析，临床特点为３６例中２２例于产后哺乳期放器。确诊方法为腹部Ｘ线和Ｂ超等。３５例行开腹术取器。３５例为闭合型ＩＵＤ。５２．８％ＩＵＤ位于子宫峡部附近。     

爱母宫内节育器超声声像图特征的探讨

目的探讨超声下监测MCu功能性宫内节育器（intrauterinecontraceptivedevices,IUD）、MCuⅡ功能性IUD、MYCuIUD（统称为爱母IUD）在宫腔内的位置和声像图特征。方法对60例放置爱母IUD的妇女应用超声监测IUD距子宫不同径线的距离,根据IUD不同类型抓拍典型声像图。结果60例纵切IUD上缘距宫底浆膜（13．46±1．91）mm,下缘距子宫内口（17．82±1．61）mm;横切上缘距宫底浆膜（左）（12．04±2．90）mm,距宫底浆膜（右）（12．55±2．63）mm。子宫纵切声像图特征：爱母3种IUD上缘在宫腔内宫底处显示明亮的、点状较强回声伴有彗星尾征。MCuIUD下缘呈短细线条状较强回声;MCuⅡ IUD、MYCu IUD下缘显示连续点状强回声伴有彗星尾征呈串珠状。子宫横切：MCu IUD的上缘在宫腔内宫底近两侧宫角处分别呈现强回声光点,周围有声晕,有的呈平行双倒“八”字,下缘记忆合金丝与中间呈现较强回声光点;MCuⅡ IUD、MYCu IUD两侧臂呈“似鱼刺样”强回声。结论爱母IUD超声声像图与常用IUD不同,需纵切与横切并用,靠连续声像图的动态变化,依据子宫中心部宫腔内膜回声这一重要标志,判断爱母IUD在宫腔中的正常或异常位置。     

环脱落与子宫内膜腔形态的关系

研究了１１２例育龄妇女的子宫内膜腔形态与宫内节育器脱落的关系。发现实验组（３９例）和对照组（７３例）所测宫腔各径线的均数与模拟的宫腔形态均无差异，而在Ｘ线片测环外缘切线的长度和子宫角距两组间差异有高度显著性Ｐ＜０．０１。在宫腔上部形态的５个主型中，仅１型两组有差异，在子宫腔下部形态的４个亚型中，Ｃ型和Ｄ型两组间差异有高度显著性Ｐ＜０．０１，宫腔第一横径与第二横径之差＜５ｍｍ，子宫腔呈桶状，环易下移、脱落或带环受孕。     

Retained Graefenberg ring intrauterine device mimicking fractured Lippes loop in-utero

This article reports a case of a retained Grafenberg IUD, which on pelvic radiography resembled a fractured Lippes Loop. The patient, a 52-year-old Chinese woman, had been fitted with a ringlike IUD 20 years earlier. 3 years after insertion, she had a miscarriage and was informed that the IUD had probably been expelled. At presentation, this patient had a 3-week history of menorrhagia. She was not anemic and systemic examination failed to reveal any abnormalities. Radiography revealed a linear radio-opague foreign body in the pelvis that looked like part of a fractured Lippes Loop. After uterine curettage, the foreign body was retrieved with difficulty and in fragments. Histopathologic examination of the endometrial cuttings showed cystic glandular hyperplasia with no evidence of malignancy or inflammation. In this case, embedment of the IUD had reduced contraceptive efficacy and made removal problematic. The force required to retrieve the device and the straightening out of its coils during the process indicate that there could have been a type 1 or 2 uterine perforation. It is assumed that the Grafenberg ring was broken and splayed out during a prior uterine curettage.     

B 超测定子宫壁厚度及对宫内节育器定位的意义

在B超监视下于经期放置宫内节育器(IUD),对144例妇女子宫底部(FUND)、前壁(ANT)及后壁(POST)的厚度进行了测定,其均数及99%正常值范围分别为14mm(11～17mm)、16mm(13～20mm)及18mm(18～23mm)。其2FUND/(ANT+POST)的比值约为0.8。另外从420例带器妇女第2年随访时 B 超检查结果分析中,亦可说明 FUND 值对 IUD 定位的意义。如用 FUND值,试以17mm 为标准,如用公式计算,暂以比值1为标准,作为 IUD 定位的参考。     

Expulsion of the intrauterine devices Lippes loop size 30 mm

To determine the factors controlling IUD expulsion (Lippes loop 30 mm), Cairo's Ain-Shams Birth Control Clinic investigated 25 women with regard to the following: 1) detailed obstetric history; 2) hystergram; 3) Lipiodol hysterosalpinography (postmenstrual cases); 4) measurement of uterine cavity; 5) dilation (Hegar's No. 8) to determine internal os integrity. In 40% of the expulsions congenital abnormalities of the uterus was found while another 40% revealed a patulous internal os. In septate and arcuate uteruses, continuous pressure on the upper part of the loop found to cause expulsion. Uterine contractions occurring during menstruation were also seen to increase chances of expulsion, particularly in cases of patulous internal os. In 20% of the cases, no anomoly was detected and expulsion was thought to have resulted from faulty insertion or irrigation of the uterus by a foreign body.     

超声引导下实时清宫术在临床上的应用价值

目的：评价超声引导下实时清宫术在临床应用的价值。方法：在206例清宫过程中实时超声观察清宫过程,超声提供子宫位置、宫腔回声等,并评价清宫术的效果。结果：清宫所用平均时间为7．1±4．3min（3～11min）,最短时间仅3min。超声引导下一次清宫成功的有198例（96．11％,198／206）。0例（0％）发生子宫穿孔。结论：超声引导下清宫术是值得提倡的诊疗方法。     

Development and Clinical Evaluation of a Newly Developed Forceps to Remove Intrauterine Foreign Bodies

Clinical use of a new forceps for foreign body removal (Intrauterine forceps) is introduced in this paper. The forceps can fit in uterine cavity during operation. A total of 310 foreign bodies in uterus, including IUD breakage, IUD embedment and remained fetal bone were removed satisfactorily by the new forceps. Two case failed.The two failed cases were not diagnosed before operation. One was a broken stainlesss teel ring and embedded into myometrium deeply. It was difficult to remove the IUD and the patient was advised to undergo a hysteroscopy diagnosis. Another one was a stainless steel V-shaped Cu IUD, which was broken into several pieces and removed by the forceps, but a small piece remained and was removed with aid of hysteroscopy.The new type of foeceps was proved to be effective and should be popularized.     

人工流产并发Ascherman综合征42例分析

本文对1980～1989年早孕人工流产的15573例病人术后并发Ascherman综合征42例(0.27％)进行了分析,经孕妇高于初孕妇(13:1)。宫颈粘连37例(88.09％),富颈宫腔粘连5例(11.90％)。宫颈及官腔内膜损伤是导致Ascherman综合征的主要原因。对人工流产术后有经期延迟、经量减少或闭经、周期性下腹痛等症状者应考虑Ascherman综合征。探、扩宫时有陈旧性血液流出是该病的主要特点。其处理方法:①探、扩宫法;②放置宫内节育器;③宫腔镜直视下分离粘连;④Foley导尿管放入宫腔。     

恶性滋养细胞肿瘤子宫穿孔

64例恶性滋养细胞肿瘤8例自发性子宫穿孔,发生率为12.5％。采用子宫切除止血,术后经多途径、多疗程化疗,其中6例健存,2例死亡。强调恶性滋养细胞肿瘤子宫穿孔应及时手术止血,手术结束时反复腹腔冲冼,术后经腹注射抗癌药物并结合全身化疗是获得治疗效果的重要措施。     

宫腔镜联合B超在宫内节育器取出困难时应用分析

目的:探讨宫腔镜联合B超在宫内节育器(IUD)取出困难时的应用价值。方法:对125例常规取IUD困难患者,采用宫腔镜联合B超检查,准确定位后经阴道或经腹取IUD。结果:宫腔镜联合B超检查发现位置正常49例,部分嵌顿41例,断裂残留28例,扭曲变形6例,腹腔内1例。除腹腔内1例经腹取出外,其余124例全部经阴道一次成功取出。结论:宫腔镜联合B超能够正确指导取器方法,提高成功率和安全性。     

宫腔镜及腹腔镜在诊治宫内节育器并发症中的应用

目的研究官腔镜及腹腔镜在诊治宫内节育器（IuD）并发症中的应用价值。方法回顾性分析应用官腔镜及腹腔镜处理42例IUD并发症的情况。结果42例具有异常或异位的IUD成功地由官腔镜和腹腔镜取出，其中38例移位、变形、嵌顿、断裂、残留在官腔的IUD以官腔镜取出，4例异位盆腹腔的IUD在腹腔镜下取出。结论官腔镜及腹腔镜诊断处理IUD并发症具有诊断明确、手术成功率高、创伤小的优点，腹腔镜处理异位于子宫外的IUD优于剖腹手术。     

B超联合宫腔镜在迷路宫内节育器中的临床应用

目的探讨迷路宫内节育器（IUD）应用超声引导下监视宫腔镜取环的临床应用价值。方法对28例常规取环困难、常规及宫腔镜取环失败者采用超声引导全程监视宫腔镜取环。结果 28例患者均顺利取出节育环,未发生子宫损伤或子宫穿孔。结论 B超引导下监视宫腔镜取环,具有直观、准确、及时、全面等优点,可减少并发症,提高手术成功率及安全性。     

MEASUREMENTS FOR LOCATING UTERINE CERVICES IN NORMAL FEMALES

In 20,915 normal married women, the position of their uterine cervices was measured by the distance from the cervix to the hymen ring and also from the cervix to the plane of tlie ischial spine. Figures shOw that taking the ischial spine as the landmark, the normal level should be below it with the lowest location 2.5 cm below the ischial spine. Mean cervix ring conjugate is 4.92±0.88 cm with straining. Therefore, it is reasonable to take the standard cervical position as more than 4 cm above the vaginal orifice or 3.5 cm from the hymen ring. Statistical analysis reveals that in uterine atrophy among old menopausal and lactating women, the uterine position is virtually higher a.nd the position of the retroposed uterus is lower. The descent of the uterus is more mark- ed in the retroposed uterus during straining. The cervical location is lower in multiparas with in- creasing in number of delivery and so multipara is an important cause of uterine prolapse.