1、曼月樂后可立即放置曼月樂后可立即放置高效，安全可逆后立即放置，安全有效，獲益 后立即放置曼月樂效果優(yōu)于含銅節(jié)育器曼月樂在的同時能夠提供額外益處患者滿意度更高，依從性更好狀況1.等，2010，中國醫(yī)學(xué)學(xué)報，32（5）479-4822. 李堅. 人工后科學(xué)方法選擇與生殖安全. 中國實用婦科與產(chǎn)科雜志, 2012, 28(9): 643-645.3.tabortion Family Planning. A practical guide for programme managers. WHO, 20054. Center for Communication Programs/Johns Hopkin

2、s, Family Planning: A Global Handbook for Providers. 20075. 臨床技術(shù)操作規(guī)范學(xué)分冊. 中華醫(yī)學(xué)會, 人民軍醫(yī), 2013.6. Grimes DA, et al. Immediatetabortal insertion of rauterine devi(review). The Cochrane Library, 2010, Ie 6.7. Fox MC, Oat-Judge J, Severson K, et al. Immediate placement of rauterine deviafterand second trim

3、estregnancy termination. Contraception, 2011;83 (1):3440.Bednarek PH, Jensen Jt. Safety, efficacy and patient acceptability of the contraceptive and non-contraceptive uses of the LNG-IUS.J Womens Health, 2010 Aug 9;1:45-58.Trul J. Contraceptive failurehe United S es. Contraception, 2004 Aug; 70(2):8

4、9-9610. Nilsson CG, Haukaa M, Vierola H, et al. Ti e concentrations of levon estrel in wosing a levon estrel-releasing IUD. Clin Endocrinol (Oxf), 1982 Dec;17(6):529-36.11. Andersson K, Batar I, Rybo G. Return to fertility after removal of a levon estrel-releasing rauterine device and Nova-T. Contra

5、ception,1992 Dec;46(6):575-84. 12. 常青,. 中華婦產(chǎn)科雜志. 2008. 43(5): 385-387.13.開; 羅燕;. 中國婦產(chǎn)科臨床雜志. 2007; 8(5): 353-35614. Pakarinen P, Toivonen J, Luukkainen T. Randomized comparison of levon estrel- and copper-releasing rauterine systems immedia y after abortion, with 5 years follow-up. Contraception. 200

6、3 Jul;68(1):31-4.15.，黃紫蓉，鄒燕. 生殖與, 2013, 33(2): 105-113.Kelekci S, Kelekci KH, Yilmaz B. Effects of levon estrel-releasing rauterine system and T380A rauterine copper device on dysmenorrhea and days of bleeding inwomen wind without adenomyosis. Contraception. 2012 Nov;86(5):458-63.Scholte. Thesis. Th

7、e Levon estrel IUD: clinical performance and impact on menstruation. University Hospital, Utrecht, 1989.Levon estrel-releasing and copper-releasing (Nova T) IUDs during five years of use a randomized comparative trial.Short M, Dallay D, Omokanye S, et al. Acceptability of the levon estrel releasing-

8、 rauterine system and etonogestrel implant: one-year results of an observational study. Eur J Contracept Reprod Health Care, 2012 Feb;17(1):79-88.Short M, Dallay D, Omokanye S, et al. Acceptability of long-acting, progestin-only contraception in Europe: A two-year prospective, non- erventional study

9、. Eur J Contracept Reprod Health Care. 2014 Feb;19(1):29-38.人工，需立即有效我國人工人工現(xiàn)狀總數(shù)居高不下，有潛在增長的趨勢50.3%的人工發(fā)生在已婦女1半數(shù)以上人流婦女曾有史，重復(fù)人流率為55.9%; 其中3 次的多次人流比例為13.5%1后需要立即有效激素水平恢復(fù)快2數(shù)天內(nèi)，促49天內(nèi):激素即恢復(fù)周期性即重新開始受到FSH刺激恢復(fù)早期后2周即可恢復(fù)75后女性在6完成WHO:后應(yīng)立即采取有效的措施, 避免重復(fù)人流！人工，需立即有效后立即放置節(jié)育器安全可行人工后可即時放置節(jié)育器中國指南：人工負壓吸宮術(shù)和鉗刮術(shù)后、中期妊娠引產(chǎn)后可即時放置

10、5后24h內(nèi)清宮術(shù)4人工率更高4后即時放置節(jié)育器，脫落率與延遲放置相同，但率及續(xù)用一項關(guān)于人工后立即放置節(jié)育器的Cochrane顯示：放置后6個月時，人流后即時放置與延遲放置的脫落率無差異(RR=2.26，95%CI=0.74-6.86)，即時放置的續(xù)用率顯著優(yōu)于延遲放置(RR=1.18， 95%CI=1.08-1.28)6節(jié)育器，其率顯著高于延遲放置組7。另一項回顧性研究結(jié)果顯示，后即時放置實際放置率（%）P0.00019100%80%60%40%20%0%23%即時組(n=221)延遲組(n=87)6%后立即放置安全可行節(jié)育器曼月樂高效，安全可逆曼月樂高效，安全可逆曼月樂高效，安全可逆8,

11、91011曼月樂高效，安全可逆即放置曼月樂安全有效，獲益曼月樂模式更優(yōu)12后放置與經(jīng)期后放置相比，4-5天放置（n=91）人流術(shù)后即時放置（n=401）7d內(nèi)清宮術(shù)同時放置（n=84）70%61.5%60%50%40%30%20%P0.0538 5%P0.0523.19 0%15.0%15.7.7% 7.1%10%4.7% 3 6%2.0% 1.2%0%1個月3個月6個月12個月后立即放置曼月樂，更快恢復(fù)規(guī)律周期13人工后立即放置曼月樂（ n=37） 經(jīng)期放置曼月樂（ n=35 ）5P=0.01143.0631.74210恢復(fù)規(guī)律周期所需時間（周期）12發(fā)點的比滴例（%）4%1%后立后立即放置

12、曼月樂安全有效，獲益即放置曼月樂，優(yōu)于含銅器141425.4%22.6%15.4%14.8%13.7%10.8%10.5%5.5%2.3%0.7%因癥取出率顯著低于含銅的Meta分析顯示, 人工節(jié)育器術(shù)后即時放置 LNG-IUS與同期放置Cu-IUD相比, 因癥取出率顯著降低，差異有統(tǒng)計學(xué)意義(RR=0.54, 95%CI=0.410.73, P0.01)15節(jié)育后立后立即放置曼月樂，優(yōu)于含銅節(jié)育器同時額外益處明顯減少量16 -17502.0401.04+241.51.00.530+17200.231000-10-20-30-40-50-0.5-0.77-1.0-1.5-1.57-373個月曼

13、月樂組-2.0-4012個月含銅節(jié)育器組置入1個月曼月樂組（n=25）置入12個月含銅節(jié)育器組（n=26）顯著緩解痛經(jīng)癥狀161.51.271.0310.50-0.5-0.78-1-1.5-1.37置入12個月曼月樂組（n=25）置入1個月含銅節(jié)育器組（n=26）-2異位妊娠率低于含銅節(jié)育器18曼月樂組（n=1821 婦女年）異位妊娠率（每百婦女年）含銅節(jié)育器（n=937 婦女年）0.3 0.1 00.020.2516與天基數(shù)線改相變比與基線相比，痛經(jīng)評分改變平均經(jīng)期失血量變化（ml )17增加減少同時額外益處患者滿意度更高，依從性更好與皮下埋植劑相比，曼月樂的患者續(xù)用率和滿意度均更高使用12個月后的續(xù)用率顯著高于依托孕烯皮下埋植劑18 使用24個