Objective To explore the clinical effects of ultrasound-guided local injection with different doses of methotrexate ( MTX ) in the treatment of Ectopic Pregnancy. Methods One hundred and thirty-two cases of patients with ectopic pregnancy were divided into two groups including 76 patients with non-operative therapy. The mean β-hCG was 19 368 ±21 423 IU/L. The mean diameter of pregnancy sac was 31. 83±19. 06 mm. All cases were treated with a single dose of MTX ( 50 mg ) via intramuscular injection in conservative treatment group. Fifty-six patients were treated with interventional therapy. The mean β-hCG was 52 872±56303 IU/L. The mean size of pregnancy sac was 44. 00±21. 80 mm. All patients were given pregnant intracapsular injection puncture with different doses ( 50-100 mg ) of MTX according to the level of β-hCG 52 372 +56 303 IU/L, and the size of pregnancy sac 44. 00±21. 80 mm, includin 25 cases with 50 mg, 18 cases with 75 mg, and 13 cases with 100 mg MTX. The patients in two groups were followed up 7 days after treatment. Results Seven days after treatment, 46 patients in the conservative treatment group had a visible decrease of β-hCG with the mean value 772± 242 IU/L.The mean reduced diameter of pregnancy sac was 5. 80±11. 70 mm, and the efficiency rate was 60.53％( 46/76 ). 32.89％ ( 25/76 ) cases had oral ulcer, nausea and vomiting etc. Seven days after interventional therapy, 52 of the 56 patients had a mean decrease of β-hCG 33 378±54 806 IU/L and the mean reduced diameter of pregnancy sac was 13. 55 ±5. 79 mm with the effficiency rate of 92.86％ ( 52/56 ).No side efffects were observed. Conclusion The ultrasound-guided local injection with different doses of MTX can treat ectopic pregnancy with high success rate, low side effects, and may be of important clinical value by properly adjusting the dose of medicine.%目的 观察不同剂量甲氨蝶呤(MTX)肌肉注射与介入治疗异位妊娠的临床疗效.方法 依据血清β-hCG测值及妊娠囊大小对132例临床和超声检查疑诊为异位妊娠的患者进行分组治疗.保守治疗组76例,患者血清β-hCG平均值(19 368±21 423)IU/L,妊娠囊平均直径(31.83±19.06)mm,采用单次肌肉注射MTX 50 mg进行治疗.介入治疗组56例,依据患者血清β-hCG测值高低(52 872±56 303)IU/L及妊娠囊大小(44.00±21.80)mm,超声引导下妊娠囊穿刺注射MTX 50 mg(25例)、75 mg(18例)及100 mg(13例)介入治疗.治疗后第7天分别对两组患者行血清β-hCG检测,超声观察妊娠囊大小及形态改变,统计患者治疗有效率及副反应发生率.结果 治疗后第7天,保守治疗组46例患者血清β-hCG值明显下降平均为(772±242)IU/L,妊娠囊缩小平均直径为(5.80±11.70)mm,治疗有效率为60.53%(46/76),副反应发生率为32.89%(25/76),表现为口腔溃疡、恶心、呕吐等症状.介入治疗组52例患者血清β-hCG值明显下降平均为(3378±54 806)IU/L,妊娠囊缩小直径平均为(13.55±5.79)mm,治疗有效率为92.86%(52/56),患者均无明显副反应发生.结论 依据患者血清β-hCG测值及妊娠囊大小,适时调整药物剂量,在超声引导下对异位妊娠患者妊娠囊定量注射MTX介入治疗较肌肉注射MTX治疗疗效好、副作用小,有重要临床意义.
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