屈螺酮炔雌醇片(Ⅱ)、依托孕烯植入剂及左炔诺孕酮宫内节育系统用于人工流产负压吸引术后的避孕效果及安全性比较

Comparison of Conception Control and Safety among Drospirenone Ethinyl Estradiol Tablets(Ⅱ),Etonogestrel Implants and Levonorgestrel Intrauterine Contraceptive System After Negative Pressure Suction for Artificial Abortion

目的:比较屈螺酮炔雌醇片(Ⅱ)、依托孕烯植入剂及左炔诺孕酮宫内节育系统用于人工流产负压吸引术后的避孕效果及安全性。方法:回顾性选取2018年1月至2019年7月期间南京医科大学附属无锡市妇幼保健院门诊收治的因意外妊娠拟行人工流产负压吸引术的健康女性,共223例。根据术后避孕方法的不同将患者分为A组[口服屈螺酮炔雌醇片(Ⅱ),n=68]、B组(皮下埋植依托孕烯植入剂,n=75)及C组(左炔诺孕酮宫内节育系统,n=80)。观察三组患者流产后阴道出血时间、月经恢复时间及子宫恢复情况等,比较三组患者术后6个月的再次计划外妊娠率、避孕措施的因症取出率和续用率,比较三组患者出血及月经情况的差异。结果:与A组比较,B组、C组患者术后阴道出血时间、月经恢复时间均明显缩短,子宫内膜厚度明显变薄,差异均有统计学意义(P<0.05),而B组、C组患者上述指标水平比较,差异均无统计学意义(P>0.05)。与C组比较,A组、B组患者术后6个月再次计划外妊娠率明显降低,避孕措施续用率明显升高,差异均有统计学意义(P<0.05);B组、C组术后6个月再次计划外妊娠率、避孕措施的因症取出率和续用率比较,差异均无统计学意义(P>0.05)。B组、C组患者出血、月经减少和闭经的发生率明显高于A组;B组患者闭经的发生率明显高于C组;C组患者经期延长的发生率明显高于A组,差异均有统计学意义(P<0.05)。结论:屈螺酮炔雌醇片(Ⅱ)、依托孕烯植入剂以及左炔诺孕酮宫内节育系统均可实现良好的避孕效果,各具优点,屈螺酮炔雌醇片(Ⅱ)对子宫内膜及月经模式影响较小,而依托孕烯植入剂、左炔诺孕酮宫内节育系统在避孕长效管理方面更有优势,应合理选择使用人群,最大限度减少突破性出血的发生。

OBJECTIVE:To compare conception control and safety among Drospirenone ethinyl estradiol tablets(Ⅱ),etonogestrel implants and levonorgestrel intrauterine contraceptive system after negative pressure suction for artificial abortion.METHODS:223 healthy women with unintended pregnancy undergoing negative pressure suction for artificial abortion admitted into Wuxi Maternal and Child Health Hospital Affiliated to Nanjing Medical University from Jan.2018 to Jul.2019 were retrospectively analyzed.The 223 patients were divided into group A(treated with Drospirenone ethinyl estradiol tablets(Ⅱ)orally,68 cases),group B(given etonogestrel implants for hypodermic implantation,75 cases)and group C(treated with levonorgestrel intrauterine contraceptive system,80 cases)according to different postoperative contraceptive methods.The vaginal bleeding time,menstrual recovery time and uterine recovery after abortion,the re-unplanned pregnancy rate,removal rate of contraceptive measures and continued use rate within 6 months after operation of the three groups were observed,differences in incidences of bleeding and menstruation of the three groups were compared.RESULTS:Compared with group A,the vaginal bleeding time and menstrual recovery time of group B and group C were significantly shorter,and the endometrial thickness was significantly thinner,with statistically significant differences(P<0.05),while there were no statistical significance in differences in the above indicators between group B and group C(P>0.05).Compared with group C,the re-unplanned pregnancy rates with 6 months after operation of group A and group B were significantly lower,and the continued use rate was significantly higher,with statistically significant differences(P<0.05);while there were no statistical significance in differences in re-unplanned pregnancy rate,removal rate of contraceptive measures and continued use rate within 6 months after operation between group B and group C(P>0.05).The incidences of bleeding,spanomenorrhea and amenorrhea of group B and group C were significantly higher than those of group A;the incidence of amenorrhea of group B was significantly higher than that of group C;the incidence of menostaxis of group C was significantly higher than that of group A,with statistically significant differences(P<0.05).CONCLUSIONS:Drospirenone ethinyl estradiol tablets(Ⅱ),etonogestrel implants and levonorgestrel intrauterine contraceptive system can all achieve better conception control.Drospirenone ethinyl estradiol tablets(Ⅱ)has less effect on endometrium and menstrual patterns,while etonogestrel implants and levonorgestrel intrauterine contraceptive system have more advantages in long-term contraceptive management,but the patients should be selected reasonably to minimize the occurrence of breakthrough bleeding.