氨甲蝶呤在腹腔镜输卵管妊娠保守性手术中应用

Applicaion of methelrexate in tubal pregnancy after conservative laparoscope

目的探讨腹腔镜输卵管妊娠保守性手术后,选择性应用氨甲蝶呤(MTX)预防持续异位妊娠发生的价值。方法对我院妇产科住院要求保留生育功能而行腹腔镜保守性手术的输卵管妊娠患者78例,监测其术前,术后第1、3、10天血人绒毛膜促性腺激素(HCG)的变化。对术后第1天HCG值较术前下降<50%者13例,应用MTX50mg/m224h行单次肌肉注射,余65例术后第1天HCG值较术前下降>50%者,不用MTX治疗。结果应用MTX治疗的13例患者无1例出现严重不良反应。全组患者无1例发生持续异位妊娠需要再手术。结论把腹腔镜输卵管妊娠保守性手术后第1天HCG水平下降情况作为预测持续异位妊娠的参数,对下降<50%者考虑及早使用MTX单次肌肉注射,可减少持续异位妊娠发生。方法简单、方便、疗效肯定,具有实用价值。

Objective To investigate the value of selective use of methelrexate (MTX) in preventing persistent ectopic pregnancy after laparoscopic conservation surgery in tubal pregnancy.Methods Seventy-eight patients with tubal pregnancy who demanded to reserve fertility,were given conservative surgery by laparoscope.The changes of human chorionic gonadotrophin (HCG) on the first,third,10th day were detected before and after operation.On the first day after operation,13 patients whose HCG decreased (<50%),as compared with that before operation,were given MTX by intramuscular injection.The other 65 patients whose HCG decreased (>50%) were not given MTX.Results None of the 13 patients who were treated with MTX had serious adverse reation.None of them occurred persistent ectopic pregnancy for second surgery.Conclusion The change of HCG one day after operation could be used as the parameters of predicting persistent ectopic pregnancy.It should be considered to use MTX as soon as possible for the patients whose HCG decrease is less than 50%.The method is simple, convenient and effective.