Obejective To study the therapeutic effect of ultrasound-guided local injection of Methotrexate ( MTX ) in conservative treatment of tubal pregnancy.Methods A total of 95 cases of early and unruptured tubal pregnancy were chosen, and they were divided into study group (51 cases) and control group (44 cases) based on the principle of voluntary.The study group received ultrasound-guided local injection of MTX, while the control group received single intramuscular injection of MTX ( 50mg/m2 ) as well as administration of mifepristone for 6 days (50mg, bid).The decrease amplitude of serumβ-hCG, mass change and adverse reactions, especially the ectopic pregnancy with fetal heart beat were compared between two groups.Meanwhile the related factors of successful treatment in the study group were analyzed.Results The cure rate and the rate of reduced mass≥30% of the study group were significantly higher than the control group (χ2 value was 8.39 and 4.17, respectively, both P<0.05), and the recovery time of serum β-hCG was significantly lower in the study group (t=5.06, P<0.05).Ultrasound showed ectopic gestational sac with fetal heart beat in 19 cases in the study group and 17 cases in the control group, and the cure rate and the rate of reduced mass≥30%of the study group were significantly higher (χ2 value was 7.06 and 5.36, respectively, both P<0.05), and the recovery time of serumβ-hCG was significantly lower than the control group (t=3.78,P<0.05) .The adverse reactions of patients in the study group were significantly lower than in the control group (χ2 =5.43,P<0.05).The analysis of successful group (group A) and unsuccessful group (group B) in the study group showed that patient's age, parity and pregnancy were not statistically different (t value was 0.06, 0.03 and 0.42, respectively, all P>0.05).The days of amenorrhea and the level of serumβ-hCG in group B were significantly higher than in group A (t value was 3.94 and 3.78, respectively, both P<0.05). Conclusion Ultrasound-guided local injection of MTX to treat tubal pregnancy, particularly the ectopic pregnancy with fetal heart beat, is a safe, effective, economical and practical method, and it is worthy of clinical use.%目的 探讨超声引导下局部注射氨甲蝶呤(MTX)在输卵管妊娠保守治疗中的疗效.方法 选择早期未破裂型输卵管妊娠患者95例,根据患者自愿的原则非随机分为研究组51例(经阴道B超引导下局部注射MTX)和对照组44例(MTX单次肌肉注射治疗,同时给予口服米非司酮治疗方案:MTX 50 mg/m2单次肌肉注射,米非司酮50mg,2次/d,用6 d).比较两组治疗后血清β-hCG下降情况、包块变化及毒副反应情况,重点比较两组之中有胎心管搏动的异位妊娠患者的治疗效果,同时对研究组中治疗成功病例的相关因素进行对比.结果 研究组治愈率和包块缩小≥30%率均显著高于对照组(χ2值分别为8.39、4.17,均P<0.05),且血β-hCG恢复时间显著低于对照组(t=5.06,P<0.05).研究组中超声下可见异位妊娠孕囊有胎心管搏动者19例,对照组中超声下可见异位妊娠孕囊有胎心管搏动者17例,研究组治愈率和包块缩小≥30%率均显著高于对照组(χ2值分别为7.06、5.36,均P<0.05),且血β-hCG恢复时间显著低于对照组(t=3.78,P<0.05).研究组患者毒副反应显著低于对照组(χ2=5.43,P<0.05).研究组中治疗成功者(A组)与治疗失败者(B组)分析显示,A组与B组患者的年龄、产次以及孕次的比较无统计学意义(t值分别为0.06、0.03、0.42,均P>0.05),B组患者的停经天数、血清β-hCG水平均显著高于A组(t值分别为3.94、3.78,均P<0.05).结论 超声引导下局部注射MTX治疗方案在输卵管妊娠治疗,尤其有胎心搏动的异位妊娠的保守治疗中具有安全、有效、经济、实用的优点,值得临床推广使用.
展开▼
