宫腔镜下输卵管注射甲氨蝶呤与口服米非司酮联用在输卵管妊娠保守治疗中的应用

Combination of Methotrexate Injection through Hysteroscopic Tubal Catheterization and Mifepristone per os in the Conservative Treatment of Tubal Pregnancy

目的评估宫腔镜下输卵管插管注射甲氨蝶呤(MTX)与口服米非司酮联用在输卵管妊娠保守治疗中的应用价值。方法以符合保守治疗标准的40例输卵管妊娠患者为研究对象,在宫腔镜引导下于输卵管插管注射50 mgMTX;术后每日口服100 mg米非司酮1次,共5 d。结果 40例患者中,有38例(95.0%)治愈,血人绒毛膜促性腺激素在3~48 d内转为正常,附件包块在16~65 d内消失,月经在28~42 d内恢复,无明显化疗副反应。术后3个月,30例患者行宫腔镜输卵管疏通检查,其中12例治疗侧输卵管通畅,2例输卵管不通,16例输卵管通而不畅。目前已有5例患者孕足月正常分娩。结论宫腔镜下输卵管注射MTX与口服米非司酮联用可安全有效地治疗早期输卵管妊娠。

Objective To evaluate the value of the combination of methotrexate(MTX) injection through hysteroscopic tubal catheterization and mifepristone per os in the conservative treatment of tubal pregnancy.Methods Forty patients who met the criteria of conservative treatment were enrolled in this study and received the combined therapy of MTX 50 mg/d injection through hysteroscopic tubal catheterization and oral mifepristone 100mg/d for 5 days.Results Of these 40 patients,38(95.0%) were cured.The human chorionic gonadotropin decreased to normal level within 3-48 days.The masses disappeared within 16-65 days.The menstruation returned normal within 28-42 days.No obvious side effect was observed.Of 30 patients who underwent hydrotubation through hysteroscopy three months later,12 patients were unobstructed,2 patients were completely obstructed,and 16 patients were partially obstructed.Five patients had full-term deliveries up to this report.Conclusion The combination of MTX injection through hysteroscopic tubal catheterization and mifepristone per os is safe and effective for early tubal pregnancy.