子宫穿孔导致输卵管嵌顿并宫内节育器异位一例

介绍1例哺乳期宫腔镜宫腔粘连分离术后子宫穿孔导致输卵管嵌顿、宫内节育器异位的病例。该患者18个月前哺乳期时行宫腔镜宫腔粘连分离术,术中同时放置T型含铜宫内节育器。3个月前出现间断下腹部坠痛,超声检查提示子宫肌层外可见节育器强回声,超越浆膜层0.5 cm。入院后行宫腹腔镜联合手术,宫腔镜检查发现宫底可见致密瘢痕组织,未见宫内节育器。腹腔镜探查发现左侧输卵管伞端及部分壶腹部嵌入子宫肌层中,其右下方可见T型节育器部分纵壁穿出子宫浆膜层突入盆腔,遂行腹腔镜嵌顿输卵管复位+宫内节育器取出+子宫修补术,术后恢复良好。

Fallopian Tube Incarceration and Ectopic Intrauterine Device Caused by Uterine Perforation: A Case Report

Describes case of fallopian tube incarceration and ectopic intrauterine device (IUD) was reported, which is caused by uterine perforation after transcervical resection of adhesions (TCRA) during lactation. The patient underwent TCRA during breastfeeding 18 months ago, and a T-shaped copper IUD was placed during the operation. Three months ago, the patient had intermittent lower abdominal pain. A strong echo of the IUD outside the myometrium, 0.5 cm beyond the serosal layer, was showed under ultrasound. After admission, the combined hysteroscopy and laparoscopic surgery were performed. The dense scar tissue was found at the fundus of the uterus under hysteroscopy, and no intrauterine device was seen. Laparoscopy showed that the fimbriae of the fallopian tube and part of the ampulla were incarcerated at the fundus of the uterus, and the longitudinal wall of the T-shaped IUD was seen passing through the uterine serosal layer. The incarcerated fallopian tube was repositioned and the IUD was removed. And then, uterine perforation was repaired. The patient was recovering well after surgery.