药物灌注栓塞治疗输卵管异位妊娠的临床研究

Clinical Study of the Treatment of Tubal Pregnancy by Combination of Embolization and Infusion With Methotrexate

目的研究经动脉药物灌注栓塞治疗输卵管妊娠的疗效、输卵管解剖及卵巢功能变化。方法对30例明确诊断输卵管妊娠的患者，行超选择子宫动脉造影后经导管注入MTX（氨甲喋呤）60～100mg，用明胶海绵颗粒对子宫动脉行完全性栓塞。对其中15例未生育患者术前及术后3、6月分别测定其性激素水平，术后第3次月经后行子宫输卵管造影。结果29例患者经治疗后2～3周孕囊缩小，血β-hCG（人绒毛膜促性腺激素）值下降至正常（小于30mIU／ml），其中15例术后女性激素水平无变化，输卵管通畅；1例由于术前孕囊较大，术后第2天孕囊破裂，行手术治疗。结论经子宫动脉化疗及栓塞是治疗输卵管妊娠的有效方法，可有效保留卵巢及输卵管的生理及解剖功能。

Objective To investigate the effect of combination of embolization and infusion with methotrexate on patients with tubal pregnancy, and to observe the changes of patients＇ ovarian function and oviductal anatomical structure. Methods 30 patients with tubal pregnancy were injected by duct with methotrexate at dose of 60 to 100 mg after uterine arteriography, and patients＇ uterine arteria were embolized with granule - sponge of gelatin. In 15 patients without procreation, the level of sex hormone was examined before and 3,6 months after the operation. And hysterosalpingography was performed 3 month after the operation. Results 2 to 3 weeks after operation, the gestation sac was shrank and the level of β - hCG was returned to normal in 29 patients. The level of sex hormone has no change and the oviduct was unobstructed in 15 patients. 1 patient received operative treatment the next day after operation because of the rupture of gestation. Conclusions The combination of embolization and infusion with methotrexate is effect on patients with tubal pregnancy, and the functions of ovary and oviduct are retained.