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。

Application of hysteroscopy and B ultrasound in removing IUD in difficult cases

Objective To evaluate the clinical value of removing IUD by hysteroscopy and B ultrasound in difficult cases.Methods After the failure of routine way, the IUD was identified first through B ultrasound only, then the IUD was identified again by the combination of hysteroscopy and B ultrasound. If the IUD was whole or part in the uterine cavity, the IUD was removed transvaginally.Results In the all 30 cases, 21 cases were normal; ectopia IUDs were found in 7 cases; one case was septate uterus and other one case was serious uterine retroversion. The results of ultrasonic examination only were correct in 25 cases, but in other 3 cases the relationships of IUD residues and endometrium or superficial tunica muscularis were misjudged, one septate uterus and one serious uterine retroversion were not found. The IUDs in 28 cases were successfully removed under the guide of hysteroscopy and B ultrasound, two IUDs were removed by laparotomy.Conclusion The main reasons for failure cases were cervical stenosis, ectopia IUD, septate uterus and abnormal uterus position. B ultrasonic examination is a safe and reliable method to confirm the position of IUD, but it would be wrong judging the relationship of IUD residue and endometrium or superficial tunica muscularis and other pathological changes in uterine cavity. The combination of hysterocopy and B ultrasound can help us to define the precise locations of the IUD and to choose a proper project to remove the IUD.