人工流产术后即时放置左炔诺孕酮宫内缓释系统的系统评价

目的:系统评价人工流产术后即时放置左炔诺孕酮宫内缓释系统(LNG-IUS)的临床疗效和安全性。方法:计算机检索Medline、Embase、Cochrane图书馆、中国期刊全文数据库、中国生物医学文献数据库、中文科技期刊数据库、万方数据资源系统。纳入比较人工流产术后即时放置LNG-IUS与人工流产术后即时放置含铜宫内节育器(CuIUD),以及人工流产术后即时放置LNG-IUS与月经期放置LNG-IUS的研究。由2位评价者独立进行文献筛选及数据提取。采用Cochrane协作网提供的RevMan5.0进行Meta分析。结果:共纳入文献17篇,患者5 512例。人工流产术后即时放置LNG-IUS与人工流产术后即时放置CuIUD相比,LNG-IUS组的带器妊娠率低,闭经发生率高,因症取出率低,脱落和不规则出血的发生率组间无统计学差异。人工流产术后即时放置LNG-IUS与月经期放置LNG-IUS相比,放置后6个月点滴出血发生率低(RR=0.42,95%CI=0.22~0.83,P=0.01);放置后12个月点滴出血、妊娠、脱落、因症取出、闭经发生率组间均无统计学差异。结论:人工流产术后即时放置LNG-IUS安全有效。

Immediate Post-abortal Insertion of the Levonorgestrel-releasing Intrauterine System: A Systematic Review

Objective: To evaluate the effectiveness and safety of immediate post-abortal insertion of the levonorgestrel-releasing intrauterine system(LNG-IUS).Methods: The Medline,Embase,Cochrane Library,CJFD,CBM,VIP and Wanfangdata were searched for researches to compare immediate post-abortal insertion of the levonorgestrel-releasing intrauterine device with copper IUD(Cu IUD) or post-menstrual insertion of the LNG-IUS.Two reviewers independently extracted data and assessed the quality of the evidence.Meta analysis was conducted using RevMan 5.0.Results: Totally,17 articles and 5 512 women were included.Comparing with immediate post-abortal insertion of the copper IUD,less pregnancy,more amenorrhea occurred among women with immediate post-abortal insertion of the LNG-IUS.Both groups experienced similar rates of expulsions and removals for medical reasons and irregular bleedings.Comparing with post-menstrual insertion,women with post-abortal insertion of the LNG-IUS experienced less irregular bleedings in 6 months after insertion(RR=0.42,95%CI=0.22~0.83,P=0.01).In 12 months after insertion,both groups experienced similar rates of pregnancy,expulsion,removal for medical reasons,amenorrhea and irregular bleedings.Conclusion: Immediate post-abortal insertion of the levonorgestrelreleasing intrauterine system(LNG-IUS) is safe and effective.