宫内节育器位置异常：症状模式与临床相关性的超声回顾性研究
该研究回顾了2021年至2023年间在西弗吉尼亚大学经盆腔超声发现的175例宫内节育器位置异常患者，其中53.1%有症状（最常见为盆腔痛或异常子宫出血），46.9%无症状；低位宫内放置是最常见的位置异常模式，而尾丝可见并不能可靠排除位置异常。结论提示症状评估和尾丝检查存在局限，超声在评估节育器位置中起核心作用。
要点
- 近半数（46.9%）节育器位置异常患者无症状，不能仅凭症状排除位置异常。
- 尾丝可见常见，但不能可靠排除节育器位置异常。
- 低位宫内放置是最常见的位置异常模式，超声是评估位置的核心手段。
核心结论
- 近半数节育器位置异常患者无症状，且尾丝可见常见，症状评估和尾丝检查存在局限，超声是评估节育器位置的核心方法。
关键影像表现/征象
- 低位宫内放置是最常见的节育器位置异常模式。
- 53.1%的患者有症状，最常见为盆腔痛或异常子宫出血；46.9%无症状。
- 尾丝可见常见，但不能可靠排除位置异常。
临床应用与阅片要点
- 临床怀疑节育器位置异常时，应以超声评估位置为准，不能依赖症状有无或尾丝是否可见来排除。
- 报告时应描述节育器具体位置（如低位宫内放置）及有无尾丝，并提示尾丝可见不等于位置正常。
局限性
- 回顾性单中心研究，仅纳入经超声发现的位置异常患者，可能存在选择偏倚。
- 未报告症状与具体位置异常类型之间的显著关联，且无人口学、器械或提供者特征与特定位置异常类型显著相关。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
OBJECTIVES: To evaluate the relationship between intrauterine device (IUD) malposition and patient-reported symptoms, identify risk factors associated with malposition, and assess the reliability of string checks compared with ultrasound findings.
METHODS: A retrospective chart review was conducted at West Virginia University between January 2021 and December 2023. Patients with malpositioned IUDs identified by pelvic ultrasound were included. Data collected included demographics, body mass index (BMI), IUD type, provider type, anatomical abnormalities, symptom profiles, and string check findings. Descriptive statistics were used to summarize the data, and associations with types of IUD malposition were assessed in the statistical analysis.
RESULTS: A total of 175 patients with malpositioned IUDs were identified. Approximately half of the patients were symptomatic (53.1%), most commonly reporting pelvic pain or abnormal uterine bleeding, while 46.9% were asymptomatic. Low intrauterine placement was the most frequent malposition pattern. String visualization was common but did not reliably exclude malposition. No demographic, device, or provider characteristics were significantly associated with specific malposition types.
CONCLUSIONS: Nearly half of patients with malpositioned IUDs were asymptomatic, and visible strings were frequently present, highlighting the limitations of symptom assessment and string checks. Ultrasound plays a central role in evaluating IUD position when clinical concern exists.
引用
- Dueñas-García OF, McGrath J, Walters M, et al. Clinical Relevance and Symptom Patterns for Malpositioned Intrauterine Devices: A Retrospective Ultrasound-Based Study. J Ultrasound Med. 2026. PMID: 41969178. doi:10.1002/jum.70262
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。