高危人工流产患者术中即时放置不同类型宫内节育器的有效性和安全性评价

Efficacy and safety evaluation of immediate placement of different intrauterine devices in high-risk patients with induced abortion

目的比较高危人工流产患者术中即时放置固定式宫内节育器或左炔诺孕酮宫内缓释系统的有效性和安全性。方法选择2020年9月至2021年2月在我院计划生育门诊行人工流产,有流产高危因素的患者共136例,术中即时放置宫内节育器,其中一组放置固定式宫内节育器(固定式节育器组),另一组放置含左炔诺孕酮宫内节育器(左炔诺孕酮组),每组各68例。随访6个月比较两组带器妊娠率和妊娠时间,节育器脱落率和因症不适取出率,月经异常、阴道出血、腹痛和宫内感染发生率。结果两组患者带器妊娠率和妊娠时间、节育器脱落率和因症不适取出率比较差异均无统计学意义(P>0.05)。左炔诺孕酮组月经异常率(闭经、月经过少、月经紊乱)高于固定式节育器组,阴道出血率(点滴出血、不规则流血)低于固定式节育器组(P<0.05),两组腹痛和宫内感染发生率比较差异无统计学意义(P>0.05)。结论高危人工流产患者流产术中即时放置固定式节育器或左炔诺孕酮宫内节育器均有较好的避孕效果,脱落率和取出率较低,并发症总体较少,安全性较好,是临床中患者可自主选择的宫内节育器。

Objective To compare the clinical efficacy and safety of immediate placement of fixed intrauterine device(IUD)or levonorgestrel-releasing intrauterine system in high-risk patients after induced abortion.Methods A total of 136 patients with high risk factors for abortion were selected to undergo artificial abortion in the family planning clinic of our hospital from September 2020 to February 2021.IUDs were placed immediately during the operation.One group was placed with a fixed intrauterine device(fixed IUD group),and the other group was placed with a levonorgestrel-containing intrauterine device(levonorgestrel group),68 in each group.The patients were followed up for 6 months.The pregnancy rate and pregnancy time during IUD placement,IUD shedding rate and removal rate due to symptoms,incidences of abnormal menstruation,vaginal bleeding,abdominal pain and intrauterine infection rate were compared between the two groups.Results There were no significant differences in pregnancy rate,pregnancy time,IUD shedding rate and removal rate due to symptoms between the two groups(P>0.05).The rate of abnormal menstruation(amenorrhea,hypomenorrhea and menstrual disorder)was higher while the rate of vaginal bleeding was lowerin the levonorgestrel group than those in the fixed IUD group(P<0.05).There were no significant differences in the incidences of abdominal pain and intrauterine infection between the two groups(P>0.05).Conclusion Immediate placement of fixed or levonorgestrel IUDs in high-risk patients with induced abortion has better contraceptive effect,lower shedding rate and removal rate,fewer complications and better safety.In clinical practice,patients can choose IUD independently.