不同水平β-HCG的异位妊娠采用药物保守治疗与腹腔镜保守手术的疗效分析

摘要

Objective To explore the efficacy of drug or laparoscopic surgery with ectopic pregnancy with different levels of β-HCG.Methods From January 2010 to December 2015, 450 patients with ectopic pregnancy from Jieyang People's Hospital were divided into two groups: 250 cases in Laparoscopic group (A) and 200 cases in the group of conservative treatment which used methotrexate (MTX) intramuscular injection and mifepristone ora.Compared the time of β-HCG declining to normal, tubal patency rate after treatment 3 months, intrauterine pregnancy rate after 6 months between the two groups.Results All operations of Group A were successful, of which were reserved ipsilateral fallopian tube, and none of them changed to open surgery.The time of β-HCG dropping to normal in group A with different concentration was significantly shorter than group B (P<0.05), and the time was shorter in the patients with low level of β-HCG (P<0.05).The difference of tubal patency rate in group A and group B after three months was statistically significant (P<0.05) and the tubal patency rate was more higher in the patients with low concentration of β-HCG (P<0.05).The intrauterine pregnancy rate in group A was significantly higher than group B (P<0.05), except for the patients with high concentration of β-HCG.Conclusions Laparoscopic play a major role in the treatment of ectopic pregnancy, especially for the patients of low level of β-HCG, which can significantly improve the pregnancy rate, and it is a treatment method which worth recommendation.%目的 探讨不同水平β-HCG异位妊娠患者采用药物保守治疗与腹腔镜保守手术的疗效.方法 收集2010年1月至2015年12月期间,揭阳市人民医院妇科收治的450例异位妊娠患者,采用腹腔镜保守手术250例,设为A组;采用甲氨蝶呤(MTX)肌肉注射联合米非司酮口服药物保守治疗200例(B组).观察两组不同β-HCG水平患者治疗后β-HCG降至正常的时间、治疗后三个月输卵管通畅率及治疗后六个月宫内妊娠率.结果 A组手术都获得成功,术中均保留患侧输卵管,无中转开腹手术的患者.治疗后β-HCG降至正常的时间,A组的低、中和高水平组均分别明显少于B组(P<0.05),且β-HCG水平越低时间越短.治疗后三个月输卵管通畅率A组高于B组,两组比较差异均有统计学意义(P<0.05),β-HCG水平越低通畅率越高(P<0.05).治疗后六个月宫内妊娠率A组低、中水平组均显著高于B组(P<0.05).结论 腹腔镜在异位妊娠的治疗过程中起到重大的作用,特别是对于β-HCG呈中低水平的患者,能显著提高妊娠率,是一种值得推荐的治疗方法.