Misra J S, Engineer A D, Tandon P
Department of Obstetrics and Gynaecology, King George's Medical College, Lucknow, India.
Acta Cytol. 1995 Jan-Feb;39(1):45-9.
Cytologic monitoring of cervical smears was carried out in 686 women receiving two modes of levonorgestrel contraception, one in the form of a subdermal implant and the other as an intrauterine device. The period of contraception with both delivery systems ranged from six months to five years. No case of malignant neoplasia was seen in any of the 44 subjects even after five years of continued levonorgestrel contraception. Preinsertion cytology revealed eight dysplastic smears (seven mild and one moderate); the lesions reverted to normal six months later and remained normal after one to four years of hormone use. A total of 19 dysplastic smears (18 mild and 1 moderate) were detected in the postinsertion smears collected after one to five years of contraception, giving an incidence of 2.8%, which was nonsignificant when compared with the control figure of 1.3%. Regression of the lesion to normal was observed in all 19 dysplasias on follow-up and in none did the dysplasia progress to a higher grade or frank malignancy. The incidence of dysplasia was more than twice as high with the intrauterine device as with the implant (4.9% vs. 2.1%). Hence, the implant appeared to be safe during five years of contraceptive use in terms of cervical pathology. However, longer follow-up of a large number of women is needed to reach a definitive conclusion.
对686名采用两种左炔诺孕酮避孕方式的女性进行了宫颈涂片细胞学监测，一种是皮下植入剂，另一种是宫内节育器。两种避孕方式的使用期限为6个月至5年。即使在持续使用左炔诺孕酮避孕5年后，44名受试者中也未发现恶性肿瘤病例。放置前的细胞学检查发现8例发育异常涂片（7例轻度和1例中度）；6个月后病变恢复正常，在使用激素1至4年后仍保持正常。在避孕1至5年后收集的放置后涂片中，共检测到19例发育异常涂片（18例轻度和1例中度），发生率为2.8%，与1.3%的对照数据相比无显著差异。随访中观察到所有19例发育异常病变均恢复正常，无一例进展为更高级别或明显恶性肿瘤。宫内节育器导致的发育异常发生率是植入剂的两倍多（4.9%对2.1%）。因此，就宫颈病理学而言，皮下植入剂在5年的避孕使用期间似乎是安全的。然而，需要对大量女性进行更长时间的随访才能得出明确结论。
