【摘要】 目的评价剖宫产瘢痕妊娠患者行子宫动脉栓塞术联合B超引导下清宫术后分别采用复方短效口服避孕药、左炔诺孕酮宫内缓释系统(曼月乐,IUS)及安全套和安全期避孕三种不同方式进行避孕所产生的不同的避孕效果。方法选取我院2014年8月~2016年8月收治的121例剖宫产瘢痕妊娠患者,随机分为三组,分别采用每日口服复方短效口服避孕药、术后子宫内立即放置IUS及仅用安全套和安全期避孕(对照组)三种不同方式避孕,其中避孕药组39例,IUS组39例,对照组43例,对三组患者行为期12个月的随访,并检查分析其B超检查结果、意外妊娠情况以及月经量的增减变化情况。结果随访12个月后结果显示,服用避孕药组患者避孕有效率为97.4%,有1例由于漏服药物导致再发剖宫产瘢痕妊娠(CSP);IUS组患者避孕效果很好,有效率为100%;对照组避孕有效率为91%,4例发生意外妊娠,其中1例为再发剖宫产瘢痕妊娠,另外3例为宫内妊娠。其中避孕药组和IUS组避孕有效率明显高于对照组,差异有统计学意义(P<0.05)。B超监测结果显示,三组患者均未出现切口破裂或损伤的情况,亦无性生活不适主诉。三组患者术后均无月经增多,进一步比较三组月经增减变化情况,术后3、6、12个月月经量均发生减少,且IUS组减少情况明显高于对照组和避孕药组,差异有统计学意义(P<0.05)。结论瘢痕妊娠患者剖宫产后采用IUS以及口服复方短效口服避孕药避孕效果明显好于安全套及安全期避孕,安全,可靠,值得推广使用。更多还原

【Abstract】 Objective To explore the contraceptive efficacy and safety of compound short-acting oral contraceptives,levonorgestrel releasing intrauterine system and condoms after cesarean scar pregnancy curettage.Methods From August 2014 to August 2016,121 patients with cesarean scar pregnancy were randomized into three groups.39 patients in the contraceptive pill group were treated with compound short-acting contraceptives,39 patients in mirena group were placed Mirena(levonorgestrel-releasing intrauterine system) after curettage immediately,and 43 patients in condom group were given condoms contraception.Patients of three groups were followed up to compare ultrasonic examination results,unexpected pregnancy and menstrual flow change.Results Patients were followed up for 12 months.The total effective rates of patients in contraceptive pill group was 97.4%,there was 1 case of recurrent CSP in contraceptive pills group because of forget to take the pills.The total effective rates of patients in Mirena patient group was 100%.The total effective rates of patients in condoms contraception group was 91%.There was 4 pregnancy occurred,including 1 case of recurrent CSP and 3 case of intrauterine pregnancy.The total effective rates of patients in contraceptive pill group and Mirena patient group were significantly higher than patients in condoms contraception group,and the difference was statistically significant(P<0.05).Ultrasonic examination showed there were no incision rupture or damage and no complaints about asexual life in the 3 groups.There was no increase in the amount of menstruation in the three groups and the decrease of menstruation in the patients of Mirena group was significantly higher than that of the condom group and the contraceptive pill group at 3,6 and 12 months postoperatively,with significant difference(P <0.05).Conclusion After uterine artery embolization combined with uterine curettage cesarean scar pregnancy patients can take marvelon and Mirena intrauterine contraception,which is safe,reliable,and can benefit patients more,and is better than only using condoms.更多还原