绝经后宫内节育器取出困难相关因素Logistic回归分析

目的探讨影响绝经后妇女宫内节育器（intrauterine contraceptive device,IUD）取出困难的相关因素。方法总结2009年3～12月绝经后妇女1818例取出IUD的临床资料,分析取器年龄、孕次、产次、人工流产次数、绝经年限、放置年限、放置时期、妇科检查有无异常、子宫位置、术前有无用药、有无扩张宫颈等与取器困难的关系。结果取器困难组的年龄、孕次、产次、绝经年龄、绝经年限、IUD放置年限、阴道和宫颈异常（主要是萎缩）、后位子宫、术前用药、扩张宫颈比例均高于顺利取器组（P〈0.05）。多因素Logistic回归分析表明,绝经后取器困难与绝经年龄、绝经年限、IUD放置时期、宫颈是否萎缩、子宫位置、术前用药、扩张宫颈及IUD类型有关。结论绝经后最好在1年内取出IUD,IUD的放置时期仍以月经干净后3～7天为宜,取IUD时要注意子宫位置。应做好充分的术前宫颈准备再行取IUD,可以提高成功率,减少并发症。

Multiple logistic analysis on correlation factors of removal intrauterine contraceptive device in difficulty in postmenopausal women

Objective To study the correlation factors affecting removal intrauterine contraceptive device （IUD） in difficulty in postmenopausal women.Methods The clinical data from 1 818 postmenopausal women with removal IUD during March to December in 2009 were retrospectively analyzed.The relationship between the degree of removal difficulty and factors such as the removal age,the gravidity,the parity,abortion numbers,postmenopausal years,the time after IUD fit,the results of gynecological examination,uterus position,the condition of premedication and cervical dilatation were analyzed.Results There was significant difference between difficult removal group and successful removal group in age,gravidity,parity,age of menopause,years after menopause,years after fitting IUD,abnormity of vagina and cervix（especially atrophy）,the ratio of retro-position of uterus,premedication and cervical dilatation （P0.05）.The results of multiple logistic analysis showed that the difficult degree of removal IUD was related to menopause age,years after IUD fit,the atrophy of cervix and uterine position,administration before IUD fit,cervical dilatation and the types of IUD.Conclusion IUD would be removed in one year after menopause and fit in 3～7 days after menstruation.It was necessary to examine the position of the uterus when removing IUD.It was also necessary to make full preparations for the cervix in order to improve the success rate of removal IUD and reduce complications.