【摘要】 目的 探究高效可逆避孕方法对人工流产术后青少年再次妊娠率的影响。方法 400例进行人工流产的青少年患者,根据患者自由选择或建议的避孕措施分为A组、B组、C组、D组,各100例。A组术后未落实高效避孕方法 , B组术后落实复方口服短效避孕药(COC), C组术后落实左炔诺孕酮宫内节育系统[商品名：曼月乐(IUS)], D组术后落实吉尼致美环、宫喜环等宫内节育器(IUD)。比较四组患者术后阴道流血时间、月经恢复时间、子宫内膜厚度及计划外妊娠率、避孕措施续用率、满意率。结果 B组术后阴道流血时间为(4.32±1.25)d、月经恢复时间为(28.77±5.15)d,子宫内膜厚度为(6.56±1.42)mm;C组术后阴道流血时间为(4.80±1.29)d、月经恢复时间为(29.80±4.32)d、子宫内膜厚度为(6.77±1.35)mm;D组术后阴道流血时间为(4.57±1.14)d、月经恢复时间为(29.35±5.04)d、子宫内膜厚度为(6.76±1.25)mm;B组、C组和D组术后阴道流血时间及月经恢复时间均明显短于A组,子宫内膜厚度大于A组,差异有统计学意义(P<0.05);B组、C组和D组术后阴道流血时间和月经恢复时间及子宫内膜厚度组间比较,差异均无统计学意义(P>0.05)。术后1、3、6个月, A组计划外妊娠率分别为4.0%、10.0%、22.0%, B组分别为0、2.0%、4.0%, C组分别为0、1.0%、1.0%, D组分别为0、1.0%、2.0%;B组、C组和D组计划外妊娠率明显低于A组,差异具有统计学意义(P<0.05);B组、C组和D组计划外妊娠率组间比较,差异均无统计学意义(P>0.05)。术后1周及术后1、3个月, B组、C组和D组避孕措施续用率比较,差异均无统计学意义(P>0.05)；术后6个月, C组避孕措施续用率97.0%和D组避孕措施续用率96.0%明显高于B组的82.0%,差异具有统计学意义(P<0.05)。B组、C组和D组满意率分别为99.0%、92.0%、93.0%,均高于A组的70.0%,差异有统计学意义(P<0.05);B组满意率高于C组和D组,差异有统计学意义(P<0.05)。结论 采用高效可逆避孕方法干预能够有效降低人工流产术后青少年的再次妊娠率,缩短术后阴道流血时间、月经恢复时间,同时可增加子宫内膜厚度,保护青少年女性长期健康。在口服COC、安装曼月乐、安装宫内节育器三种方式中,患者可能更容易接受口服避孕的方式,其安全性也较高,但长期使用的安全性仍需要进一步探究。更多还原

【Abstract】 Objective To investigate the effect of long-acting reversible contraceptive methods on the repregnancy rate of adolescents after induced abortion. Methods A total of 400 adolescent patients who underwent induced abortion were divided into group A, group B, group C, and group D according to the contraceptive measures freely chosen or recommended, with 100 cases in each group. Group A did not implement efficient contraceptive methods after surgery, group B implemented the combined oral contraceptive(COC) after surgery,group C implemented the levonorgestrel intrauterine device system [trade name: Mirena] after surgery, and group D implemented the intrauterine device(IUD) such as the GeneFix ring and Gongxi ring after surgery. The postoperative vaginal bleeding time, menstrual recovery time, endometrial thickness and unplanned pregnancy rate,contraceptive continuation rate and satisfaction rate were compared among the four groups. Results In group B,the postoperative vaginal bleeding time was(4.32±1.25) d, the menstrual recovery time was(28.77±5.15) d,and the endometrial thickness was(6.56±1.42) mm; in group C, the postoperative vaginal bleeding time was(4.80±1.29) d, the menstrual recovery time was(29.80±4.32) d, and the endometrial thickness was(6.77±1.35) mm; in group D, the postoperative vaginal bleeding time was(4.57±1.14) d, the menstrual recovery time was(29.35±5.04) d, and the endometrial thickness was(6.76±1.25) mm. The postoperative vaginal bleeding time and menstrual recovery time in group B, group C and group D were significantly shorter than those in group A, and the endometrial thickness was greater than that in group A, and the differences were statistically significant(P<0.05).There was no statistically significant difference in postoperative vaginal bleeding time, menstrual recovery time and endometrial thickness between group B, group C and group D(P>0.05). At 1, 3, and 6 months after surgery,the unplanned pregnancy rates were 4.0%, 10.0%, and 22.0% in group A, 0, 2.0%, and 4.0% in group B, 0, 1.0%,and 1.0% in group C, and 0, 1.0%, and 2.0% in group D, respectively. The unplanned pregnancy rates of group B,group C and group D were significantly lower than that of group A, and the difference was statistically significant(P<0.05). There was no statistically significant difference in the unplanned pregnancy rate among group B, group C and group D(P>0.05). At 1 week, 1 month and 3 months after surgery, there was no statistically significant difference in contraceptive continuation rate of among group B, group C and group D(P>0.05). At 6 months after surgery, the contraceptive continuation rate in group C was 97.0% and the contraceptive continuation rate in group D was 96.0%, which were significantly higher than 82.0% in group B, and the differences were statistically significant(P<0.05). The satisfaction rates of group B, group C and group D were 99.0%, 92.0%, and 93.0%,which were higher than 70.0% of group A, and the difference was statistically significant(P<0.05). The satisfaction rate of group B was higher than that of group C and group D, and the difference was statistically significant(P<0.05).Conclusion Long-acting reversible contraceptive method intervention can effectively reduce the re-pregnancy rate of adolescent patients after induced abortion, and reduce the postoperative vaginal bleeding time and menstrual recovery time. In the three methods of oral COC, installation of Mirena, and installation of intrauterine device, patients may be more likely to accept oral contraceptive methods, and its safety is also higher, but the safety of long-term use still needs to be further explored.更多还原