节育器异位导致剖宫产术后子宫腹壁瘘一例

子宫腹壁瘘是一种少见的子宫手术并发症。节育器是一种经济简便的避孕方式,但节育器异位可能造成不良后果。报道1例剖宫产术后13年因节育器异位导致的子宫腹壁瘘的病例。患者因原剖宫产瘢痕处包块于外院切开引流,但伤口经久不愈,5个月后再次就诊该院,行腹壁瘘口造影诊断为子宫腹壁瘘,随后于中国人民解放军东部战区总医院进一步诊疗。入院后,常规清创换药1周,待炎症局限,行腹壁子宫瘘道切除术,术中发现节育器异位是导致子宫腹壁瘘的主要原因,取出节育器,完整切除腹壁、子宫瘘道及周围炎症组织,术后予以消炎及伤口常规换药治疗,最终成功治愈。完整切除瘘道和去除诱因是子宫腹壁瘘手术成功的关键。临床应重视妇女宫内节育器放置术后的随访,避免节育器嵌顿或异位导致严重并发症的发生。

Ectopic Intrauterine Device Causing Uterocutaneous Fistula after Cesarean Section: A Case Report

Uterocutaneous fistula is a rare complication of uterine surgery. Intrauterine device is a simple and economical contraceptive method, but ectopic intrauterine device will cause adverse consequences. We reported a case of uterocutaneous fistula that caused by ectopic intrauterine device after 13 years of cesarean. The incision and drainage of the abdominal mass at the scar of cesarean section was performed in the patient at another hospital firstly, but the wound didn′t heal for a long time. She was then diagnosed as uterocutaneous fistula by abdominal fistula angiography after 5 months at the same hospital. After that, the patient was admitted to our hospital for further treatment. In the first one week after her admission, routine debridement and dressing change were carried out. Excision of abdominal uterine fistula was operated after the wound inflammation was controlled. Ectopic intrauterine device was considered to be the main cause of uterocutaneous fistula. Intrauterine device was removed, and excision of belly flaps, uterine fistula and peripheral inflammatory tissue was performed. After operation, she was treated with anti-inflammatory therapy and routine dressing change of wound. At last, she was successfully cured. Removing the fistula completely and eliminating etiology are two key operations to the success of abdominal fistula surgery. More attention should be paid to the follow-up after intrauterine device placement, so as to avoid serious complications caused by intrauterine device incarceration or ectopic.