生殖医学杂志2018，Vol.27Issue(4)：305-309,5.DOI:10.3969/j.issn.1004-3845.2018.04.003
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
Effect of different route of methotrexate administration combined with minimally invasive surgery in treatment of fallopian pregnancy
摘要
Abstract
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.关键词
输卵管妊娠/持续性异位妊娠/米非司酮/甲氨蝶呤Key words
Fallopian pregnancy/Persistent ectopic pregnancy/Mifepristone/Methotrexate引用本文复制引用
李玮,鲁意,金建华,汪晓茜..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[J].生殖医学杂志,2018,27(4):305-309,5.基金项目
温州市科技局项目(Y20170572) （Y20170572）
