依托孕烯植入剂对子宫肌瘤患者避孕价值的研究

Efficacy and safety of etonogestrel implant for contraception in patients with uterine myoma

关键词:  依托孕烯植入剂  口服避孕药  避孕套  子宫肌瘤

Key words:  etonogestrel implant  oral contraceptive  condom  uterine myoma

摘要:

目的评估依托孕烯植入剂在子宫肌瘤患者中避孕的安全性及可行性。 方法选择2021年1月—2022年3月上海市嘉定区妇幼保健院就诊有避孕需求且合并子宫肌瘤的育龄期女性90例，依据使用不同的避孕措施，分为A组(依托孕烯植入剂)、B组(避孕套)和C组(口服屈螺酮炔雌醇片)，每组各30例，分别记录不同避孕方式后的3、6、12个月时子宫肌瘤体积大小、血雌孕激素水平变化、避孕措施的脱落率、避孕有效率、不良反应发生率、患者满意度。 结果三组受试者在子宫肌瘤体积大小、脱落率、避孕有效率方面差异均无明显统计学意义（P＞0.05）；三组受试者在应用上述避孕措施3个月后雌激素水平比较，差异无统计学意义（P＞0.05），但在应用 6个月及12个月后差异均有统计学意义（P＜0.05）；三组受试者在应用上述避孕措施3、6、12个月后孕激素水平比较，差异均有统计学意义（P＜0.05）；三组不良反应比较: 与B组比较，A组和C组主要表现为月经模式的改变（P＜0.05），在体重变化、白带改变、痤疮、乳房胀痛、性欲减退、应用过敏不适等方面，组间比较差异无统计学意义（P＞0.05)；三种避孕方式中,A组满意度最高。 结论对于子宫肌瘤患者，若使用依托孕烯避孕，不仅避孕有效率高，副反应及并发症少，雌孕激素波动范围小，患者满意度高，且肌瘤在应用期间无明显增长，值得临床医生在子宫肌瘤患者中推广应用。

Abstract:

ObjectiveTo evaluate the efficacy and safety of etonogestrel implant for contraception in patients with uterine myoma. MethodsA total of 90 women of childbearing age with uterine fibroids, who had contraceptive needs and visited Shanghai Jiading District Maternal and Child Health Hospital from January 2021 to March 2022 were enrolled. For contraception, 30 patients received etonogestrel implant(group A), 30 patients used condom(group B) and 30 patients received oral spirosterone ethinylestradiol tablets(group C). The volume of uterine myoma, the level of serum estrogen and progesterone, the drop-out rate of contraceptive measures, the rate of effective contraception, the incidence of adverse reactions and patient satisfaction were compared among three groups at 3 months, 6 months and 12 months after taking contraceptive measures. ResultsThere were no significant differences in uterine myoma volume, contraceptive effectiveness rate and prolapse rate among three groups(P＞0.05). There was significant difference in estrogen levels after 6 months and 12 months among three groups(P＜0.05), but not at 3 months after using contraceptive measures(P＞0.05). There were significant differences in progesterone levels among three groups at 3, 6 and 12 months after using contraceptive measures(P＜0.05). The main adverse reaction for group A and C was the change of menstrual pattern. The incidence of body mass change, leucorrhea, acne, breast pain, decreased libido and allergy was not significantly different among three groups(P＞0.05). ConclusionFor contraception in patients with uterine myoma, etonogestrel implant shows high effective rate, few adverse effects and complications, less fluctuation of estrogen and progesterone levels, high patient satisfaction, and not increasing myoma volume, which is worthy of promotion and application clinically.