刘命风 马学标 黄水英 游宇园

【摘要】 目的 分析宫腔镜下高危人工流产术后即时放置宫内节育器的可行性。方法 60例高危人工流产术患者， 随机分为观察组与对照组， 各30例。观察组患者宫腔镜下高危人工流产术后即时放置宫内节育器， 对照组患者B超引导下高危人工流产术后即时放置宫内节育器。比较两组手术相关指标（术中出血量、手术时间、术后节育器下移）、并发症（子宫穿孔、清宫不全）发生情况。结果 两组均无术后节育器下移发生。观察组术中出血量（15.23±1.27）ml、手术时间（26.17±0.25）min與对照组的（15.01±1.28）ml、（26.15±0.27）min比较， 差异无统计学意义（P>0.05）。观察组并发症发生率为0， 低于对照组的13.33%， 差异有统计学意义（P<0.05）。结论 宫腔镜下高危人工流产手术后即时放置宫内节育器具有可行性。

【关键词】 宫腔镜;高危人工流产术;宫内节育器

DOI：10.14163/j.cnki.11-5547/r.2020.30.013

Feasibility study of immediate placement of intrauterine device after high-risk induced abortion under hysteroscope   LIU Ming-feng， MA Xue-biao， HUANG Shui-ying， et al. Department of Gynecology， Huidong County Maternal and Child Health Hospital， Huizhou 516300， China

【Abstract】 Objective   To analyze the feasibility of immediate placement of intrauterine device after high-risk induced abortion under hysteroscope. Methods   A total of 60 patients with high-risk induced abortion were randomly divided into observation group and control group， with 30 cases in each group. The observation group underwent high-risk induced abortion under hysteroscopy， and the intrauterine device was placed immediately after the operation; the control group underwent high-risk induced abortion under the guidance of B-ultrasound， and the intrauterine device was placed immediately after the operation. The operative related indicators （amount of intraoperative hemorrhage， operation time， no downward movement of intrauterine device after operation） and occurrence of complications （uterine perforation and incomplete curettage） were compared between the two groups. Results   There was no downward movement of intrauterine device after operation in both groups. The amount of intraoperative hemorrhage （15.23±1.27） ml and operation time （26.17±0.25） min in the observation group had no statistically significant difference compared with （15.01±1.28） ml and （26.15±0.27） min in the control group （P>0.05）. The incidence of complications in the observation group was 0， which was lower than 13.33% in the control group， and the difference was statistically significant （P<0.05）. Conclusion   It is feasible to place the intrauterine device immediately after the high-risk abortion under the hysteroscope.

【Key words】 Hysteroscope; High-risk induced abortion; Intrauterine device

高危人工流产是指早期妊娠孕妇由于某些生殖器官局部或全身性的病理因素， 在人工流产手术时增加了难度， 具有较高的危险性， 增加了术中或术后并发症的发病率及死亡率， 若患者多次进行人工流产术还可能造成其宫颈及其内膜受到损坏， 形成宫颈、宫腔粘连， 导致痛经、不容易受孕， 甚至终生不孕等严重并发症， 对患者具有严重的危害[1]。因此， 对于人工流产术后暂时无生育要求需长期避孕的女性， 采取一种安全、有效、长期、可逆的避孕方式进行避孕具有重要的意义。目前， 需长时间避孕的女性常选取宫内节育器放置术进行避孕。宫内节育器放置术为一种安全、有效且可逆性强的长期避孕措施， 在术后若有生育需求， 将宫内节育器取出大多数能够进行正常生育， 不会对女性的生育功能造成严重影响， 故在临床上也得到了广泛的应用。在行……