延期使用左炔诺孕酮Ⅰ型皮下埋植剂避孕的有效性观察  

A Study on the Long-term Efficacy of Norplant Implants in Women

作　　者：张帝开[1] 郭璇华[1] 冯淑英[1] 余妙真[1] 李海刚[1] 吴金浪[2] 杨冬梓[1] 邝健全[1] 

机构地区：[1]中山大学附属第二医院,广东广州510120 [2]中山大学北校区,广东广州510080

出　　处：《实用妇产科杂志》2004年第1期49-51,共3页Journal of Practical Obstetrics and Gynecology

基　　金：广东省科委攻关项目基金资助 (962 2 0 4 4 0 2 )

摘　　要：目的 :探讨延期使用左炔诺孕酮Ⅰ型皮下埋植剂避孕的有效性。方法 :对 2 99例使用左炔诺孕酮Ⅰ型埋植剂超过 5年以上的妇女 ,观察其避孕的有效性及子宫内膜的形态学变化。结果 :延期使用组月经表现较为正常 ,累积妊娠率为 0 33/10 0妇女年。植入后平均体重和血红蛋白均增加 ,与植入前比较差异有显著性 ,P <0 0 5。对 4 8例延期使用者进行观察 ,宫腔镜直视下见子宫内膜变薄者 37例 ,占 77 0 8% ,且内膜覆盖良好 ;光镜下子宫内膜腺体数量减少 ,分布不均匀 ,部分呈萎缩型改变 ,间质蜕膜样改变 ,疏松 ,轻度水肿 ;电镜下腺上皮细胞呈低柱状 ,胞体变小 ,微绒毛脱落 ,稀疏 ,分泌颗粒减少 ,线粒体肿胀 ,外膜消失 ,基质变淡 ,甚至呈空泡状 ,粗面内质网扩张 ,此外 ,间质细胞出现细胞凋亡。结论 :延期使用左炔诺孕酮Ⅰ型皮下埋植剂避孕是有效的 ,可抑制子宫内膜的发育 ,对子宫内膜是安全的 ;体重和血红蛋白的增加不是影响左炔诺孕酮埋植剂延期使用的因素。Objective:To assess the long- term efficacy of Norplant implants in Guangzhou women.Methods:The contraceptive efficacy of 299 women who exposure to Norplant for more than 5 years was assessed and changes of endometrial morphology were investigated.Results:The women who received long-term contraceptive implants manifested normal menstruation. During the observation period, the accumulated pregnancy-rate was 0.33/100 women. Mean body weight and hemoglobin were significantly higher after implant than before( P <0.05). Thinned endometrium were shown by hysteroscopy and 77.08% of them had a good cover of endometrium . The endometrial gland reduced in number and unevenly distributed. Some glands were atrophic. A decidual change of stroma with mild edema was presented. Electron-microscopy showed that, the epithelial cells of the glands presented low columnar. The volume of the cell became smaller. Microviu was sloughed . The excretory granules decreased in number. The mitochondria became swollen and its external membrane disappeared. The matrix became less stained and even became in vacuole-shape. The Rough endoplasmic reticulum presented extension. In addition, stroma cells appeared apoptosis.Conclusions:The subdermal contraceptive implant Norplant is effective, and it has a suppressive effect on endometrium and safety to the endometrium. The increase of mean body weight and Hb after implant should not lead to the discontinuation of the subdermal implant.

关 键 词：左炔诺孕酮Ⅰ型皮下埋植剂 避孕 有效性 子宫内膜 形态学变化 

分 类 号：R979.21[医药卫生—药品] R169.41[医药卫生—药学]