Broso P R, Buffetti G
Divisione di Ostetricia e Ginecologia, USSL n. 40, Ospedale Civile, Ivrea Torino.
Minerva Ginecol. 1994 Sep;46(9):505-9.
The intrauterine device (IUD) is an effective and relatively safe contraceptive. Approximately 15% of women of child-bearing age in Italy use the IUD. The major health risks associated with IUD use are perforation of the uterus, pregnancy (both intrauterine and ectopic), and pelvic inflammatory disease. Perforation of the uterus by an IUD is a serious complication and this is possible both during the insertion and later. Perforation of the uterus is rare, but potentially fatal. The incidence is of 0.12-0.68/1000 insertion. Although some patients have signs and symptoms suggestive of perforation (pain or bleeding), many are apparently asymptomatic at the time the diagnosis of perforation is made. Perforation is often suspected or diagnosed when the IUD string is no longer visible at the external os. A patient who has sustained a perforation is not protected against pregnancy. Numerous factors affect perforation: the type of IUD, the uterine size and position, timing of the insertion in relation to the last delivery or abortion and the experience of the clinical. Serious consequences have been described, such as severe damage to the viscera (i.e. bowel, kidney) and/or peritonitis. The diagnosis is clinical, ultrasonic, radiological and coelioscopic. Coelioscopic diagnosis makes it possible to choose the method of treatment. In experienced hands, this method is rapid, the hospitalization required short and the sequelae simple.
宫内节育器（IUD）是一种有效且相对安全的避孕方法。在意大利，约15%的育龄妇女使用宫内节育器。与使用宫内节育器相关的主要健康风险包括子宫穿孔、妊娠（宫内妊娠和异位妊娠）以及盆腔炎。宫内节育器导致的子宫穿孔是一种严重并发症，在放置过程中和之后都有可能发生。子宫穿孔虽罕见，但有潜在致命风险。其发生率为每1000次放置中有0.12 - 0.68例。尽管一些患者有提示穿孔的体征和症状（疼痛或出血），但许多患者在诊断穿孔时并无明显症状。当在宫颈外口看不到宫内节育器尾丝时，常常会怀疑或诊断为穿孔。发生穿孔的患者无法防止妊娠。许多因素会影响穿孔情况：宫内节育器的类型、子宫大小和位置、放置时间与上次分娩或流产的关系以及临床医生的经验。已经描述了一些严重后果，如对内脏（如肠道、肾脏）的严重损伤和/或腹膜炎。诊断方法包括临床诊断、超声诊断、放射学诊断和腹腔镜诊断。腹腔镜诊断有助于选择治疗方法。在经验丰富的医生手中，这种方法快速，所需住院时间短，后遗症也简单。
