应用宫腔镜诊断和处理难以取出的宫内节育器

本文介绍35例常规取节育器困难或失败的病例,经国产XG-3型宫腔镜检查定位,35例中有27例病人的宫内节育器或其碎片在宫腔内(其中1例不锈钢节育器恰套在粘膜下肌瘤蒂部、1例的节育器完全碎裂、1例断裂的T 形节育器横臂断段大部嵌入宫壁),8例未见宫内节育器(其中4例剖腹取出,另4例估计脱落而未作处理)。27例中,19例在宫腔镜直视下用蟹爪钳取出;2例用微钩取出;6例用长弯血管钳取出,效果均良好。由此认为应用宫腔镜诊断和处理断裂或嵌顿的难以取出的宫内节育器是极好的办法。

Diagnosis and Treatment of Missing IUDs by Hysteroscopy

We used XG-3 bent tube type hysteroscope and grasping forceps made in China onthirty-five patients with missing IUDs who had previously undergone unsuccessful dilationand curettage even for 3 times in an endeavor to retrieve the lost IUDs by hysteroscopicexamination alone or in combination with other methods.5% Dextrose in water was usedto distend the uterine cavity in all cases.The types of IUDs and hysteroscopic visualizationin 35 cases with missing IUDs were shown in Table 1(omitted).Of the 35 cases in the group,abnormal IUDs or their broken pieces were removed by grasping forceps in 19 cases and byminiature hook in 2 cases under hysteroscopic control.After location of the IUDs by thehysteroscope the missing IUDs were removed by Kelly's forceps in 6 cases,and by laparo-tomy in 4 cases.The results were shown in Table 2(omitted).There was a case of submucous myoma hitched by the metallic contraceptive ring.An IUD was found to be broken up completely in the uterine cavity in one case and the mostpart of the broken transversal arm of a T-type IUD was embedded into the myometrium witha small tip projected into the uterine cavity in another case.All of these were removed bygrasping forceps under hysteroscopic control.The above mentioned data show that hysteroscopy has been proved to be useful,partic-ularly in the management of patients with broken and/or embedded pieces of IUDs.