摘要
目的探讨甲氨蝶呤术前预处理或术中给药联合腹腔镜保守手术治疗输卵管妊娠的疗效差异。方法选取上海市江湾医院2010年1月至2014年12月收治的因输卵管妊娠行腹腔镜保守手术治疗患者200例，将患者分两组每组各100例，进行回顾性分析。A组：先单次肌内注射甲氨蝶呤（MTX）50mg／kg，24～48h后行腹腔镜保守手术。B组：腹腔镜保守手术取出输卵管妊娠物后，于妊娠处输卵管浆肌层局部注射2ml溶有20mg甲氨蝶呤的生理盐水。比较两组患者术中情况、术后体温、血B．绒毛膜促性腺激素（HCG）下降、术后持续性异位妊娠发生率及输卵管通畅情况的差异。结果A组术中出血少[（23±16）ml，P〈0．01]，手术时间短[（46±15）min，P〈0．05]，术后第4、7天血β—HCG下降更快（P〈0．05）；两组术后输卵管通畅情况比较（39例比19例），差异有统计学意义（P〈0．01）；两组均无持续性异位妊娠发生，术后体温、术后血β—HCG降至正常的时间比较差异无统计学意义（P〉0．05）。结论甲氨蝶呤术前预处理或术中给药联合腹腔镜保守手术治疗输卵管妊娠成功率高，但术前给药可缩短手术时间，减少术中出血及输卵管组织结构破坏，是有生育要求的异位妊娠患者较理想的治疗方法。
Objectives To compare pretreatment and intra-operative methotrexate （MTX） administration when combined with laproseopy in the treatment of salpingocyesis. Methods All 200 patients with salpingoeyesis treated with laproseopy in Jiangwan Hospital from Jan, 2010 to Dee, 2014 were enrolled and divided into group A and B, 100 patients in each. In group A, the patients were administered with MTX 50 mg/kg by intramuscular injection 24 -48 h before the surgery. In group B, the patients were administered with MTX 20 mg in 2 ml normal saline to the target tubal seromuscular layer after the eetopie pregnancies were removed. Then, the following characteristics would be compared between the groups including the medical condition during the operation, post-operative body temperature, serum G-human ehorionic gonadotropin （β-HCG） reduction, the rate of refractory ectopic pregnancy and tubal patency. Results The bleeding volume during the surgery （ P 〈 0. 01 ） was significantly reduced and the operation duration （ P 〈 0. 05 ） was significantly shortened in group A. The serum β-HCG level （ P 〈 0. 05 ） was also significantly reduced 4 and 7 days after the surgery in group A. There was significantly difference on the rate of tubal patency （ P 〈 0. 01 ） between the groups. There was no refractory eetopic pregnancy in either groups after the surgery. And there were no significant differences on the post-operative temperature, period of serum 13-HCG moving to the normal level between the groups （ P 〉 0.05 ） . Conclusions Both pretreatment and intra-operative MTX administration showed good efficacy. But the surgery duration shortening, bleeding decreasing during the operation and tubes retaining were seen in group A. For this reason, we believe pro-operative MTX administration would be better for the patients with childbearing requests.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2015年第45期3663-3666,共4页
National Medical Journal of China
基金
上海市卫生局医学重点专科课题（ZK2012817）
关键词
异位妊娠
腹腔镜
甲氨蝶呤
Ectopic pregnancy
Laproscopy
Methotrexate
