不同甲氨蝶呤给药方案联合微创保守手术对输卵管妊娠的治疗效果

摘要

目的 评价不同甲氨蝶呤(MTX)给药途径联合米非司酮及微创保守手术治疗输卵管妊娠的临床效果及术后持续性异位妊娠(PEP)发生率. 方法 选择2015年2月至2016年12月在我院因输卵管妊娠接受腹腔镜保守治疗的116例患者,按随机数表法分为对照组和观察组,每组58例.所有患者给予腹腔镜保守手术治疗,术后口服米非司酮.对照组在术中取出妊娠物后给予MTX 20 mg局部注射于输卵管近端的浆肌层;观察组在术前给予MTX 50 mg/kg单次肌肉注射,24～48 h后行腹腔镜保守性手术.比较两组患者手术情况、β HCG恢复时间及术后体温、月经来潮时间及再次妊娠时间及PEP发生率、输卵管通畅率,血清血管内皮生长因子(VEGF)、抑制素A(INH A)水平.比较两组的生活质量及不良反应. 结果 观察组的术中出血量、手术时间均显著低于对照组(P＜0.05);而两组的β-HCG恢复时间、术后体温、月经来潮时间及再次妊娠时间均无统计学差异(P＞0.05);观察组PEP发生率显著低于对照组,输卵管通畅率显著高于对照组(P＜0.05);治疗后,两组的血清β-HCG、孕酮、VEGF、INH-A水平均较治疗前显著下降(P＜0.05),且治疗后观察组的各指标水平均显著低于对照组(P＜0.05),而生活质量核心简表(QOL-C30)总评分显著高于对照组(P＜0.05).两组患者不良反应发生率无统计学差异(P＞0.05). 结论 MTX术前预处理可显著缩短手术时间,减少术中出血量,且更有利于避免输卵管组织结构的二次破坏,保护输卵管功能,值得临床推广应用.%Objective:To evaluate the clinical efficacy of different route of methotrexate(MTX)administration combined with mifepristone and minimally invasive conservative surgery in the treatment of fallopian pregnancy and the incidence of persistent ectopic pregnancy(PEP)after surgery.Methods:A total of 116 fallopian pregnancy patients undergoing laparoscopic conservative treatment in our hospital from February 2015 to December 2016 were divided into control group and observation group according to random number table method,with 58 patients in each group.All patients received laparoscopic conservative surgery and postoperative oral mifepristone.The patients in the control group were treated with 20 mg of MTX injection locally into the proximal fallopian muscle layer after the removal of pregnancy.The patients in the observation group received laparoscopic conservative surgery 24 to 48 hours after a single intramuscular injection of MTX 50 mg/kg.The operative conditions,recovery time of β-HCG and postoperative body temperature,menstruation time,re-pregnancy time,incidence of PEP,fallopian patency and serum levels of VEGF and INH-A were compared between the two groups.The quality of life and adverse reactions in both groups were compared.Results:The operation time in the observation group were significantly shorter than that in the control group (P ＜0.05).There was no significant difference in recovery time of β-HCG levels,postoperative body temperature,menstruation time and re pregnancy time between the two groups(P＞0.05).The incidence of PEP in observation group was significantly lower than that in control group,and fallopian patency rate was significantly higher than that in control group(P＜0.05).The levels ofβ-HCG,progesterone,VEGF and INH-A after treatment were significantly lower than before treatment in both groups(P＜0.05).After treatment,the levels of each index in the observation group were significantly lower than those in the control group(P＜0.05),but the total score of QOL-C30 in observation group was significantly higher than that in control group (P＜ 0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusions:MTX preoperative treatment can significantly shorten the operation time and reduce the amount of intraoperative bleeding and conducive to avoid the secondary destruction of fallopian tissue structure,so as restore the oviduct function.It is worthy of clinical application.