黄琳娟，李聪，余琴（重庆医科大学附属第一医院妇科，重庆400000）

·论著·

宫腔镜取环困难患者调查及原因分析*

黄琳娟，李聪△，余琴
（重庆医科大学附属第一医院妇科，重庆400000）

目的回顾性分析宫腔镜下取环患者的流行病学因素，发现困难取环的高危因素，以利于临床对取环方式的优化选择。方法选取该院2015年9～12月门诊宫腔镜下困难取环患者145例，统计患者的年龄构成、住址差异、绝经时限、取环原因，发现宫腔镜下取环的高危因素。结果所有患者均成功取环，无并发症发生。非主城区患者［57.24% （83/145）］较主城区患者［42.76%（62/145）］多，差异有统计学意义（P＜0.05）；宫腔镜下取环患者多集中在30～44岁［46.21%（67/ 145）］；采用宫腔镜取环的绝经时段集中于绝经1～5年［35.29%（18/51）］和绝经10年以上［31.37%（16/51）］者；宫腔镜下取环的主要原因为绝经［35.17%（51/145）］，其次为出血性疾病［28.28%（41/145）］，再次为节育器嵌顿或断裂［20.69%（30/ 145）］，最后为取环失败［15.86%（23/145）］。结论对于取环高危因素及可能并发内膜器质性病变的患者而言，宫腔镜优于临床传统的取环和盲视诊刮术，对于高危因素的患者推荐选择。

宫内避孕器排出；宫腔镜；绝经后期；数据收集

【Abstract】Objective To retrospectively analyze the epidemiological factors in the patients with removal of the intrauterine device（IUD）by hysteroscopy to find the high risk factors for difficult removalof IUD in order to optimize the clinicalselection of IUD removalmodes.Methods A total of 145 cases of hysteroscopic IUD removal in our hospital from September to December2015were collected.The age structure，address difference，time limit of menopause，causesof IUD removal were statistically analyzed for finding the high risk factors and guiding the clinical selection of IUD removalmethods.Results All cases were successful in IUD removal with out complication soccurrence.The non-urban patients［57.24%（83/145）］were more than the urban patients［42.76%（62/145）］，the difference was statistically significant（P＜0.05）；the patients with hysteroscopic IUD removal were concentrated in 30-44 yearsold［46.21%（67/145）］；the time period forhysteroscopic IUD removalwas concentrated in 1-5 yearsaftermenopause［35.29%（18/51）］andmore than 10 yearsaftermenopause［31.37%（16/51）］；menopause［35.17%（51/145）］and hemorrhagic disease［28.28%（41/145）］were themost common factors，followed by IUD incarceration or breakage［20.69% （30/145）］，finallywas the failure of IUD removal.Conclusion For the patientswith high risk factorsand the possibility of complicating endometrial lesions，hysteroscopy is better than the clinical traditional removal and blind curretage，which are recommended and selected for the patientswith high risk factors.

【Key words】Intrauterine deviceexpulsion；Hysteroscopes；Postmenopause；Data collection

宫内节育器（IUD）是我国女性最常用的避孕方式，在临床上广泛使用。由于IUD嵌顿、粘连、残留、穿透子宫等并发症导致取环困难，需在宫腔镜下取出［1-2］。有统计发现，20%～50%的女性在放置IUD后，会出现上述子宫异常出血症状，尤其是经量增多，常高达15%～40%［3］，严重影响女性的生活质量。异常子宫出血、腰腹疼痛、带环妊娠等节育器并发症也常常成为宫腔镜下检查及取环等操作的临床适应证。……