种类、放置时期和技术影响宫内节育器失败的系统评价

目的:评价宫内节育器(IUD)种类、放置时期和放置技术对其失败率的影响。方法:用循证医学方法,检索7个数据库和9种相关杂志,纳入相关临床研究并予以质量评价,提取原始研究的数据和进行合并分析。对无异质性可合并的文献使用Meta分析,对不可合并的资料作定性系统评价。结果:纳入16项(共计23295例)研究,因文献间异质性大,仅进行定性系统评价。结果显示活性带铜IUD较惰性IUD的失败率低;在放置时期比较中,剖宫产后即时放置IUD的脱落率低于阴道分娩后放置者;人流后即时和哺乳期放置IUD的脱落率可能较高,但哺乳期放置因症取出率低;服务提供人员置器技术与脱落率相关。结论:活性IUD值得推广使用。对阴道分娩后放器者应该加强随访,哺乳期放置IUD的脱落率可能较高,但因症取出率低,为知情选择提供了依据。放置IUD应该由技术娴熟和有经验的服务提供者完成。因纳入分析的文献以回顾性病例分析和病例-对照研究为主,结论需要进一步论证。

Different types,periods of insertion and skills of providers for the failure of intrauterine device:a systematic review

Objective:To systematically assess the different types,periods of intrauterine device(IUD)-insertion and skills of providers that affect the failure of IUD.Methods:Seven medical databases including CBM,CNKI,CMAC,CMCC,EMBASE,MEDLINE and Cochrane library were searched,and nine relatives journals were additionally searched by hand.Two reviewers screened and evaluated the literatures independently according to the advance standards.Because of the heterogeneity of the included studies,only qualitative systematical review was conducted.Results:16 studies(23 295 cases)had been included for further analysis,including randomized controlled trial,clinical controlled trail,cohort study and case-control study.Available data showed that active IUDs with Cu had lower rates of failure than that of inert IUD.IUD-insertion after uterine-incision delivery rather than spontaneous delivery had lower expulsion rate.Women with breastfeeding appeared to have lower risk of bleeding.The service provider's skill and experience was tied up with the failure of IUD.Conclusion:Active IUD is better than inert IUD.As the high expulsion rate of IUD-insertion,women with the inserted IUD after spontaneous delivery should be paid more attention to.Women with breast-feeding have higher expulsion rate,while lower discontinue rate due to medical reasons.The service of IUD-insertion should be proved by the skilled providers.More high quality and longer follow-up studies should be conducted to confirm the above conclusions in the future.