不同剂量甲氨蝶呤联合输卵管开窗取胚术在输卵管妊娠患者中的应用效果

Application effect of different doses of Methotrexate combined with salpingostomy on patients with tubal pregnancy

目的分析输卵管开窗取胚术结合不同剂量甲氨蝶呤(MTX)治疗输卵管妊娠对患者输卵管通畅及再孕影响。方法回顾性分析2022年6月2023年6月收治的行输卵管开窗取胚术治疗的72例输卵管妊娠患者临床资料,其中36例患者联合50 mg常规剂量MTX治疗(常规组),36例联合25 mg低剂量MTX治疗(低剂量组)。记录两组手术前后人绒毛膜促性腺激素(HCG)变化及术后HCG恢复正常所需时间、MTX治疗相关不良反应,比较两组术后3个月输卵管通畅情况及预后再妊娠情况。结果低剂量组术后7、14 d的HCG均低于常规组,差异有统计学意义(P<0.05),两组HCG恢复正常所需时间比较,差异无统计学意义(P>0.05)。低剂量组MTX治疗相关不良反应总发生率低于常规组,差异有统计学意义(P<0.05)。两组术后3个月输卵管通畅情况比较,差异无统计学意义(P>0.05)。两组患者术后随访4~16个月,组间再次宫内妊娠率、同侧再次异位妊娠率、流产率比较,差异均无统计学意义(P>0.05)。结论输卵管开窗取胚术联合25 mg低剂量MTX局部注射治疗输卵管妊娠效果良好,可达到与50 mg常规剂量相似的输卵管通畅效果,再妊娠情况也与常规剂量相近,但25 mg低剂量MTX不良反应更少,安全性更高。

Objective To analyze the influence of salpingostomy combined with different doses of Methotrexate(MTX)on tubal patency and re-pregnancy in the treatment of tubal pregnancy.Methods The clinical data of 72 patients with tubal pregnancy who underwent salpingostomy from June 2022 to June 2023 were retrospectively analyzed.Among the patients,36 cases were treated with conventional-dose(50 mg)MTX(conventional group),and 36 cases were given low-dose(25 mg)MTX(low-dose group).The human chorionic gonadotropin(HCG)changes before and after surgery,time required for HCG to return to normal level after surgery and MTX treatment-related adverse reactions were recorded in the two groups.The tubal patency status and prognosis of re-pregnancy at 3 months after surgery were compared.Results The HCG levels in the low-dose group were lower than those in the conventional group at 7 and 14 days after surgery,and the differences were statistically significant(P<0.05).There was no statistical significance in the time required for HCG to return to normal level between the two groups(P>0.05).The total incidence rate of MTX treatment-related adverse reactions in low-dose group was lower than that in conventional group,with statistical significances(P<0.05).The tubal patency revealed no statistical difference between the two groups at 3 months after surgery(P>0.05).The patients in the two groups were followed up for 4-16 months after surgery.There were no statistical differences in the intrauterine re-pregnancy rate,ipsilateral ectopic re-pregnancy rate and abortion rate between the two groups(P>0.05).Conclusion Salpingostomy combined with local injection of low-dose(25 mg)MTX has a good effect in the treatment of tubal pregnancy.It can achieve the tubal patency effect similar to that of conventional dose(50 mg),and the re-pregnancy situation is also similar to that of conventional dose,but low-dose(25 mg)MTX has fewer adverse reactions and higher safety.