Clinical application of hysteroscopy in treatment of menopausal labyrinth IUD[Abstract] Objective To investigate the value of hysteroscopy i
Clinical application of hysteroscopy in treatment of menopausal labyrinth IUD
[Abstract] Objective To investigate the value of hysteroscopy in the treatment of menopausal labyrinth IUD (IUD). Methods a retrospective analysis was performed on 1998.1---2007.12 patients with menopausal labyrinth in our hospital from IUD68. Results all 68 cases were successfully removed the abnormal IUD, including 67 cases of normal, deformation, fracture, incarceration, remaining in the uterine cavity IUD in hysteroscopic operation, 1 cases of ectopic pelvic peritoneal IUD in laparoscopic removal, no complications. Conclusion the diagnosis of IUD in the labyrinth of the menopause is clear, the success rate is high, the wound is small. IUD ectopic pelvic cavity should be selected laparoscopic removal.
[Abstract] intrauterine device hysteroscopy menopause treatment
The clinical application of hysteroscopy dealing with menopausal ectopic intrauterine device (IUD).Yin Yong, Liu Cuihua, Tang shanling. Department of Obstetrics and Gynecology, The Traditional Chinese Medicine (TCM) Hospital ofTaizhou, Jiangsu, 225300, China.
[Abstract] Objective To study the value of hysteroscopy in the diagnosis andtreatment of menopausal ectopic IUD. Methods menopausal ectopic IUD hospitalized 68 patientswith in our department from January were taken out 1998 toDecember 2007 by hysteroscopy.The results were retrospectivelyanalyzed. Results All of the cases with ectopic IUD were successfully 68 takenout, 67 normal or abnormal IUD of deformed or broken or remained in uterus weresuccessfully taken out under hysteroscope, and ectopic IUD in abdominal 1 case andpelvic cavity were successfully taken out under laparoscope. No operativecomplication occurred. Conclusions Hysteroscopic operations have the advantagesof clear diagnosis, higher successful rate and minimal invasion for the Take out ofmenopausal IUD. IUD out uterine cavity had better choosehysteroscopic and laparoscopic operations. of Ectopic ectopic
[Key word] Intrauterine (IUD), Hysteroscopy, Menopause, Treatment., Device
Intrauterine device (IUD) is one of the most commonly used contraceptive methods in women of childbearing age in china. Menopausal women due to ovarian dysfunction, genital atrophy, should be taken within one year after menopause. Some women due to all symptoms, coupled with concerns about thinking, failed to take out in time, so that the incidence of complications increased. In our hospital from January 1998 to December 2007, 68 cases of menopausal women with routine access to the failure of the ring IUD of the use of IUD guide hysteroscopy, satisfactory results are reported as follows:
1 materials and methods
1.1 general information age 45-67 years old, average 52.3 years old; menopause is 1-12 years, an average of 5.2 years; the ring of 10-32 years, average 20.2 years; have reproductive history, pregnancy 2-9, average 4.5; all conventional ring ring failure, failed 1 times, a total of 31 cases, a total of 18 failed 2 times a total of 14 cases, 3 cases failed, failed 4 times, a total of 5 cases, including 23 cases of IUD failure in ultrasound or X-ray again take ring failure; hospital outside the hospital in 27 cases, 41 cases; 34 cases of metal ring, ring type T 16 cases, 18 cases of uterine ring ring; before the conventional fluoroscopy again.
XG-8 type 1.2 hysteroscopy equipment Shanghai jinbaolong Optical Electronic Technology Research Institute of production, tube diameter 6.5mm, equipped with a cold light source machine and a set of three pipe pressure control device and forceps forceps, and a ring extracting hook etc..
1.3 operation method with 5% glucose as distending medium, 30 minutes before the intramuscular injection of atropine 0.5mg (with Rumina 100mg, tachycardia and other contraindications excluded). Patients after emptying the bladder lithotomy position, routine disinfection vulva vagina after dilatation of cervix before on both sides of 3 points and 9 points each injection of 2% lidocaine 2ml, the probe proved the depth of the uterine cavity and uterine position, with Hegar's dilation cervical dilatation to 7, implantation of hysteroscopic mirror body, to clear vision. From outside to inside careful observation of cervical and uterine lumen around walls, fundus, especially bilateral uterine horn, understanding IUD location, shape, and degree of incarcerated fracture and residual IUD location.
2.1 hysteroscopy results IUD in 2 normal cases, microscopically, IUD is silver white, round flash, on the edge of palace and the palace wall on both sides of the bottom tangent; the distortion of IUD in 3 cases, see IUD intrauterine torsion deformation under microscope; IUD rupture in 16 cases, microscopically were metal ring fracture. IUD is irregular, a horseshoe shaped, semi-circular, rod, twist; IUD incarcerated in 36 cases, microscopically, mild incarceration in 14 cases, distorted incarceration in 18 cases, 4 cases of severe incarcerated intrauterine contraceptive device, only a part; residual IUD in 10 cases, microscopically, birth control for the residual period of varying lengths, ranging from 1-3cm up to a 5 ring wire were removed; otherwise a case of intrauterine contraceptive device no traces.
2.2 treatment of hysteroscopy, the IUD position was normal in 2 cases, with a ring extracting hook removed successfully, 3 cases of distorted ring positioning with a long curved hemal. 16 cases of fracture and 10 cases of residual ring ring in hysteroscope under first see IUD off stump to reveal the internal uterine position shape through operation hole into the crab catch IUD with foreign body forceps to withdraw from the palace cavity mirror. 36 cases of incarcerated ring IUD was observed in the uterine cavity shape and depth of the embedded part after positioning in hysteroscope, take the ring hook IUD hook or by rotating around the surface of IUD endometrial curette and superficial muscular layer, and then the operation hole crab grasping forceps clamp, IUD mirror body together with the exit. Successfully removed in 32 cases, and 4 cases of IUD incarcerated in the uterine wall, intrauterine contraceptive device only part, to catch crab clamp removed the IUD pull to the cervical internal slippage during several times, with a long curved forceps pull to the cervix, scissors cut the IUD run out, the other 1 cases of intrauterine contraceptive device no traces prompt, ectopic IUD, under general anesthesia by laparoscopy for ” O” ring, by the greater omentum, separation of adhesion, exposure and IUD Schnabel, greater omentum bipolar coagulation hemostasis, suture and uterine rupture, intraoperative irrigation with saline . Take the ring after all underwent routine diagnostic curettage, endometrial pathological examination, including 34 cases of blood clots, only a small amount of mucus and broken glandular epithelium, 18 cases of atrophic endometrium, 16 cases of inflammatory cell infiltration, endometrial cancer cases not found. All cases were treated with hysteroscopy to observe the condition of the uterus, and to determine whether there was any injury or residual in the muscularis and tunica intima. Postoperative patients with oral antibiotics and hemostatic drugs. 1 cases received laparoscopic surgery and received intravenous infusion. There was no obvious discomfort in the patients after operation, and no complications occurred in 1 cases.
Intrauterine device (IUD) because of its long-term, safe, reversible, economical and convenient and no interference of the advantages of living by the majority of women of childbearing age with its use rate of about contraception will bring a variety of 46.3%, complications such as IUD IUD, which lost a distorted, residual, fracture, incarceration, or penetration piercing the uterus resulting in difficult removal, especially for IUD fracture, in addition to the traditional method of previous open surgery to take out, there is no law. The advent of hysteroscopic surgery provides a new method for the removal of intrauterine foreign bodies .
Menopausal women due to the decline of ovarian function, the level of estrogen in the body, the various organs of the degenerative changes, shrinking the uterus, the cervix hardens. This change is exacerbated with prolonged menopause. The IUD size unchanged, IUD is often caused by incarcerated, causing the ring to increase the degree of difficulty, coupled with poor cervical elastic flattening, cervical ring, difficult, long operation time, easy to cause the failure of ring infection, and postmenopausal genital tract immunity, long-term storage ring are more likely to cause infection. It is reported that more than 2 years of difficulty in the acquisition of  menopause for more than 18%, more than 6 years of up to 35%, so that more than one year after menopause is appropriate. In this group, 4 cases of severe incarceration, the age of all over the age of 55 years, the ring length of 20-28 years.
For a long time, the operation of the uterine cavity is the operation of the doctor on the basis of clinical experience, although there are B ultrasound and X-ray monitoring guidance, but are indirect images, rather than direct vision. Pelvic fluoroscopy only suggests the presence of IUD in the pelvic cavity, can not determine whether IUD in utero, but not the shape and position of the tip in the uterine cavity IUD, B-mode ultrasonography can display IUD in the uterine cavity, but not clear in the form of IUD. The application of hysteroscopy, uterine cavity can determine whether there is IUD, and can be directly observed IUD type, shape, position and embedding position and depth, peep IUD abnormalities, avoid blind hook, the uterine injury is reduced to the minimum, this operation process is safe and reliable, high success rate, through hysteroscopy found ring fracture, distortion and residual of 29 cases, accounting for 42.6%, is one of the common causes of postmenopausal women take ring failure. In this group, 67 cases of labyrinthine IUD were successfully taken out in different ways under the condition of hysteroscopy. When the ring is embedded, ring ring fracture difficulties, accurate positioning is necessary for incarceration, broken ring, to understand the shape and location of hysteroscopy after operation through the hole into the crab grasping forceps clamping IUD exit together with the mirror body and out of the group of 1 cases were found, suggesting that IUD remove ectopic, laparoscopic surgery, hysteroscope success rate accounted for 98.5%, similar to the  reported in domestic Yao, that hysteroscopic lost ring has great application value. Hysteroscope IUD should be appropriate use of antibiotics and hemostatic agent, proper rest, to ring must again by ultrasound or X-ray examination, to ensure that the IUD has no residual, 68 cases had no infection and residue.
Menopausal women taking ring failure may be due to normal uterine cervical atrophy hardens, probe through difficulties, take the ring hook in the uterine cavity operation is relatively difficult, prone to cause uterine wall injury, increased pain, caused by prolonged time of extraction. Hysteroscopy before intramuscular injection of atropine and 0.5mg Rumina 100mg, can reduce pain, easy operation, because the menopausal women cervical atrophy hardens, on both sides of intramuscular injection of 2% lidocaine 2ml cervical block anesthesia, cervical muscle relaxation. 2 cases of cervical dilatation in patients with difficult hard, I use the disposable plastic double lumen catheter is inserted into the uterine cavity injection of 2% lidocaine 5ml, can make the cervical dilatation and relaxation, tissue distal sensory paralysis, reduce intraoperative stimulation, relieve pain, make IUD smooth out, thus avoiding the difficulties and expanding uterus traction caused by bradycardia nausea and vomiting other symptoms, patients with no obvious discomfort. In addition, for many years, menopause palace mouth closed, tissue elasticity is difficult to expand, hysteroscopy and take ring equipment is difficult to enter the uterine cavity, using premarin and Neal estradiol, mifepristone, in order to increase the elasticity of the cervical tissue, Miyaguchi relaxation. If the menopause time is too long, genital atrophy is obvious, estimate the difficulty of the device without any symptoms, also can not take the device. Some people think that IUD does not have a significant impact on the health of postmenopausal .
In summary, hysteroscopy can not only be used for the diagnosis of the location of the labyrinthine IUD, through its operating hole, but also can be directly under the IUD removal, eliminating the pain of open, and safe, rapid and thorough. In short, the lost IUD, the practicability and superiority of the methods of diagnosis and treatment by hysteroscopy compared with a traditional one, it is worthy of clinical application.
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