门诊宫腔镜联合腹部超声在节育器取出困难中的价值
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摘要
目的研究分析门诊宫腔镜联合腹部超声在节育器取出困难中的应用价值。方法本研究中的观察对象均为本院收治的节育器取出困难患者,选择2016年4月～2018年1月84例患者开展门诊宫腔镜联合腹部超声检查,对节育器位置、节育器同子宫肌层之间的关系等进行全面的了解。除此之外,将上述84例患者根据单双号分组的方式分为两组,每组42例,对照组患者均接受门诊宫腔镜取环,观察组则在其基础上联合腹部超声取环,比较两组患者的手术指标、疼痛程度以及术后并发症发生情况。结果对导致节育器取出困难的因素进行分析,发现诸多因素当中,嵌顿、残留断裂占比、绝经后宫颈萎缩占比均较高,宫腔粘连占比、异位占比以及黏膜下肌瘤占比相对而言较低;观察组患者的手术耗时与手术出血量均明显少于对照组,其疼痛评分以及术后并发症发生率均明显低于对照组,差异有统计学意义(P <0.05)。结论节育器发生嵌顿及断裂残留等均为导致节育器取出困难的主要因素,门诊宫腔镜联合腹部超声在节育器取出困难中应用,可以通过直接检查患者宫腔内环情况,对取环的方式进行选择,以提升取环的成功率。
Objective To study the value of outpatient hysteroscopy combined with abdominal ultrasound in the difficulty of removing the Intra Uterine Device(IUD). Methods A total of 84 patients with difficulty in removing the IUD who admitted to the outpatient hysteroscopy from April 2016 to January 2018 were divided into an observation group and a control group,with 42 cases in each group.The control group underwent hysteroscopy IUD removal operation in the outpatient department,and the observation group was further combined with abdominal ultrasound on the basis of the observation.The above patients were examined by outpatient hysteroscopy combined with abdominal ultrasound,so that they had a full understanding of the location of IUD and the relationship between IUD and myometrium.Surgical indexes,pain degree and postoperative complications were compared between the two groups. Results By analyzing the factors leading to the difficult removal of IUD,it was found that the proportion of incarceration,residual fracture and post-menopausal cervical atrophy were higher among various factors,the proportions of uterine adhesion,ectopic and submucosal fibroids were relatively low.The operation time and blood loss in the observation group were significantly less than those in the control group,and the pain score and the incidence of postoperative complications in the observation group were significantly lower than those in the control group(P < 0.05). Conclusion Incarceration and fracture residue of the IUD are the main factors leading to the difficulty of removing the IUD.Outpatient hysteroscopy combined application of abdominal ultrasound in the synthetic out difficulties,can be directly check in patients with an IUD, choose to take out the synthetic way,to improve the success rate of take out IUD.
Objective To study the value of outpatient hysteroscopy combined with abdominal ultrasound in the difficulty of removing the Intra Uterine Device(IUD). Methods A total of 84 patients with difficulty in removing the IUD who admitted to the outpatient hysteroscopy from April 2016 to January 2018 were divided into an observation group and a control group,with 42 cases in each group.The control group underwent hysteroscopy IUD removal operation in the outpatient department,and the observation group was further combined with abdominal ultrasound on the basis of the observation.The above patients were examined by outpatient hysteroscopy combined with abdominal ultrasound,so that they had a full understanding of the location of IUD and the relationship between IUD and myometrium.Surgical indexes,pain degree and postoperative complications were compared between the two groups. Results By analyzing the factors leading to the difficult removal of IUD,it was found that the proportion of incarceration,residual fracture and post-menopausal cervical atrophy were higher among various factors,the proportions of uterine adhesion,ectopic and submucosal fibroids were relatively low.The operation time and blood loss in the observation group were significantly less than those in the control group,and the pain score and the incidence of postoperative complications in the observation group were significantly lower than those in the control group(P < 0.05). Conclusion Incarceration and fracture residue of the IUD are the main factors leading to the difficulty of removing the IUD.Outpatient hysteroscopy combined application of abdominal ultrasound in the synthetic out difficulties,can be directly check in patients with an IUD, choose to take out the synthetic way,to improve the success rate of take out IUD.
引文
[1]谢桂芹,崔艳艳,马棣.宫腔镜及腹腔镜在困难取环术中的应用体会[J].淮海医药,2015,33(1):32-33.
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[3]李丽娟.超声联合宫腔镜在老年妇女困难取环术中的应用价值分析[J].河南医学研究,2017,26(16):2992-2993.
[4]林经萍,盛晓滨.超声设备及宫腹腔镜联合应用在计划生育并发症诊疗中的地位[J].齐齐哈尔医学院学报,2017,38(9):1004-1005.
[5]吴文.宫腔镜直视与超声引导在宫内节育器嵌顿取出术中的对比研究[J].中国医学前沿杂志(电子版),2016,8(3):86-88.
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[7]刘晶慧.门诊宫腔镜联合腹部超声在节育器取出困难的临床分析[J].中国实用医药,2017,12(24):83-84.
[8]黄泓,刘灵霞,张璇,等.超声引导在宫内节育器嵌顿取出术中的应用[J].护理实践与研究,2016,13(13):56-57.
[9]肖晓君,张玉娟,林琪,等.三维声影成像联合三维表面成像对宫内节育器异常的超声诊断[J].实用医学影像杂志,2016,17(4):341-342.
[10]黄琳娟,李聪,余琴.宫腔镜取环困难患者调查及原因分析[J].现代医药卫生,2016,32(8):1124-1126.
[11]黄晓文.门诊宫腔镜1465例分析[J].广东医学,2016,37(z1):135-136.(下转第135页)
[12]王安汝,陈新华.宫腔镜取环术用于宫内节育环嵌顿的临床效果观察[J].中国基层医药,2017,24(3):400-403.
[13]姚丽菊.用宫腔镜下取环术对常规取环失败患者进行取环的效果探讨[J].当代医药论丛,2017,15(17):91-92.
[14]Shabaruddin FH,Chai BS,Woo YL,et al.Cost Variations of Inpatient,Daycare and Outpatient Hysteroscopy in ATertiary-Care Hospital in Malaysia[J].Value in Health,2016,19(7):A820.
[15]盛文丽,金洁.宫腔镜联合B超应用于难取IUD30例临床分析[J].中国冶金工业医学杂志,2016,33(5):535-536.
[16]郭俊利,葛华.宫腔镜腹腔镜治疗难取宫内节育器79例临床分析[J].内蒙古医学杂志,2017,49(3):288-290.
[17]李彦军,吴俊改,李红华,等.宫腔镜联合B超在取出嵌顿宫内节育器中的应用[J].临床和实验医学杂志,2014,13(6):489-491.
[18]蓝关翠,叶咏菊,石明晴.困难节育器取出方式的探讨及分析[J].中国现代医生,2018,56(12):136-140.
[19]吴友高.宫腔镜和腹腔镜在宫内节育器异位诊治中的价值[J].中国当代医药,2017,24(2):88-90.
[20]姜福英,蒋素英,周萍芳.宫腔镜用于取出嵌顿宫内节育器的临床应用[J].医学理论与实践,2013,26(5):629-630.
[2]兰卉,赖香梅.宫腹腔镜在宫内节育器取出困难时的应用价值[J].中国实用医药,2016,11(29):172-173.
[3]李丽娟.超声联合宫腔镜在老年妇女困难取环术中的应用价值分析[J].河南医学研究,2017,26(16):2992-2993.
[4]林经萍,盛晓滨.超声设备及宫腹腔镜联合应用在计划生育并发症诊疗中的地位[J].齐齐哈尔医学院学报,2017,38(9):1004-1005.
[5]吴文.宫腔镜直视与超声引导在宫内节育器嵌顿取出术中的对比研究[J].中国医学前沿杂志(电子版),2016,8(3):86-88.
[6]徐泽荣.经阴道三维超声在宫腔内疾病中的诊断价值分析[D].银川:宁夏医科大学,2016.
[7]刘晶慧.门诊宫腔镜联合腹部超声在节育器取出困难的临床分析[J].中国实用医药,2017,12(24):83-84.
[8]黄泓,刘灵霞,张璇,等.超声引导在宫内节育器嵌顿取出术中的应用[J].护理实践与研究,2016,13(13):56-57.
[9]肖晓君,张玉娟,林琪,等.三维声影成像联合三维表面成像对宫内节育器异常的超声诊断[J].实用医学影像杂志,2016,17(4):341-342.
[10]黄琳娟,李聪,余琴.宫腔镜取环困难患者调查及原因分析[J].现代医药卫生,2016,32(8):1124-1126.
[11]黄晓文.门诊宫腔镜1465例分析[J].广东医学,2016,37(z1):135-136.(下转第135页)
[12]王安汝,陈新华.宫腔镜取环术用于宫内节育环嵌顿的临床效果观察[J].中国基层医药,2017,24(3):400-403.
[13]姚丽菊.用宫腔镜下取环术对常规取环失败患者进行取环的效果探讨[J].当代医药论丛,2017,15(17):91-92.
[14]Shabaruddin FH,Chai BS,Woo YL,et al.Cost Variations of Inpatient,Daycare and Outpatient Hysteroscopy in ATertiary-Care Hospital in Malaysia[J].Value in Health,2016,19(7):A820.
[15]盛文丽,金洁.宫腔镜联合B超应用于难取IUD30例临床分析[J].中国冶金工业医学杂志,2016,33(5):535-536.
[16]郭俊利,葛华.宫腔镜腹腔镜治疗难取宫内节育器79例临床分析[J].内蒙古医学杂志,2017,49(3):288-290.
[17]李彦军,吴俊改,李红华,等.宫腔镜联合B超在取出嵌顿宫内节育器中的应用[J].临床和实验医学杂志,2014,13(6):489-491.
[18]蓝关翠,叶咏菊,石明晴.困难节育器取出方式的探讨及分析[J].中国现代医生,2018,56(12):136-140.
[19]吴友高.宫腔镜和腹腔镜在宫内节育器异位诊治中的价值[J].中国当代医药,2017,24(2):88-90.
[20]姜福英,蒋素英,周萍芳.宫腔镜用于取出嵌顿宫内节育器的临床应用[J].医学理论与实践,2013,26(5):629-630.