摘要目的 探讨三维经阴道超声评估宫内节育器(IUD )位置异常及不良反应的发生情况,指导IUD的正确选择.方法 选择2016年7月至2018年2月来我院健康体检的女性志愿者作为研究对象,获取其带环时间、带环次数等信息,通过三维经阴道超声观察并记录IUD类型、位置情况等,回顾性分析不同种类型IUD位置异常、不良反应及宫颈病变的发生情况.结果 2 113 例符合标准的受试者纳入研究,其中爱母环423例,圆形环506例,宫型环405例, T型环372例, γ环407例.带环后不良反应的发生率高达34 .07%,不同IUD不良反应发生率不同,爱母环不良反应发生率最高,与圆形环、宫型环、 T型环、 γ环比较差异有统计学意义(47 .99% 对 25 .88%, 27 .41%, 37 .10%, 33 .66%;均P ＜0 .05) .同一不良反应发生的IUD类型亦不同,爱母环和γ环腰痛率高于其余三种IUD ,爱母环与圆形环、宫型环、 T 型环比较差异有统计学意义(23 .4% 对 15 .71%, 14 .07%, 13 .71%;均 P ＜0 .01) .不同类型IUD位置异常的发生率不同,圆形环下移率最高,与爱母环、 γ环比较差异有统计学意义(6 .32% 对3 .30%, 3 .19%;均 P ＜0 .05) ,与宫型环、 T型环下移率差异无统计学意义(6 .32%对3 .45%, 4 .30%;均 P ＞0 .05) ;爱母环嵌顿率最高,与圆形环、宫型环、 T型环比较差异有统计学意义(3 .07% 对0 ,0 .25%, 0 .54%;均 P ＜0 .01) .宫型环与γ环宫内旋转率较高,与爱母环、圆形环、 T型环比较差异有统计学意义(均 P ＜0 .01) .孕次＞1次和带环次数≥2次均与IUD不良反应的发生有关(P ＜0.05).T型环宫颈糜烂发生率最高,与爱母环、圆形环、宫型环、γ环比较差异有统计学意义(30 .65% 对16 .78%, 16 .80%, 18 .02%, 17 .69%;均 P ＜0 .01) .结论 女性置环后不良反应的发生率较高,不同类型IUD的不良反应和不良反应发生率均不同;不同类型 IUD位置异常的发生率不同;孕次和带环次数与IUD不良反应的发生有关.

abstractsObjective To investigate the incidence of abnormalities and adverse reactions of intrauterine device ( IUD) by three‐dimensional transvaginal ultrasound ,and guide the correct selection of IUD . Methods Female volunteers who came to our hospital for health check‐up from July 2016 to February 2018 were selected as subjects to obtain information of the belt loop time and number of loops . T hree‐dimensional transvaginal ultrasound was used to observe and record the IUD types and positions . T he incidence of location abnormalities ,adverse reactions and cervical lesions of differnet types of IUD were retrospectively analyzed . Results T wo thousand one hundred and thirteen eligible subjects were included in the study ,including 423 cases of McuIUD ,506 cases of circular ring ,405 cases of uterine ring ,372 cases of T‐ring and 407 cases of γ ring . T he statistical analysis showed that the incidence of adverse reactions after wearing rings was as high as 34 .07% ,and the adverse reaction rate of different IUD was different . McuIUD had the highest incidence of adverse reactions ,compared with the circular ring ,the uterine ring ,the T‐ring , and the γ ring ( 47 .99% vs 25 .88% ,27 .41% ,37 .10% ,33 .66% ; all P ＜ 0 .05 ) . Different IUD had different incidence of adverse reactions . T he low back pain rate in McuIUD and γ ring were higher than the other 3 IUDs . T he low back pain rate of McuIUD was higher than the circular ring ,the uterine ring and the T‐ring ( 23 .4% vs 15 .71% ,14 .07% ,13 .7 1% ; all P ＜ 0 .01 ) . Different types of IUD had different incidence of location anomalies . T he descending rate of the circular ring was higher than that of the McuIUD and γ ring ( 6 .32% vs 3 .30% ,3 .19% ; all P＜ 0 .05 ) ,and no statistically significant difference compared with the uterine ring and T‐ring ( 6 .32% vs 3 .45% ,4 .30% ; all P ＞0 .05 ) . T he incarceration rate of the mother ring was higher than that of the circular ring ,uterine ring and T‐ring ( 3 .07% vs 0 ,0 .25% ,0 .54% ;all P ＜0 .01) . T he intrauterine rotation rate of uterine ring and γ ring were higher than that of McuIUD , circular ring and T‐ring ( all P ＜0 .01) . Pregnancy ＞1 and ring times ≥2 were related with the occurrence of adverse reactions of IUD ( P ＜ 0 .05 ) . T he incidence of cervical erosion in the T‐ring was the highest compared with the McuIUD ,circular ring ,uterine ring ,and γ ring ( 30 .65% vs 16 .78% ,16 .80% ,18 .02% , 17 .69% ; all P ＜0 .01) . Conclusions The incidence of adverse reactions is higher in women with different types of IUD . T he incidence of different types of abnormal IUD position is different . T he frequency of pregnancy and band ring are related to the occurence of adverse veactions to IUD .