经阴道超声引导穿刺注射甲氨蝶呤治疗未破裂型早期输卵管妊娠

Transvaginal ultrasound guided methotrexate injection for unruptured early tubal pregnancy

目的探讨经阴道超声引导穿刺注射甲氨蝶呤（MTX）治疗未破裂型早期输卵管妊娠的临床疗效与价值。方法对32例未破裂型早期输卵管妊娠（附件包块〈4cm，血β—hCG〈4000mIU／ml，无明显腹腔内出血，生命体征平稳）经阴道超声引导穿刺输卵管妊娠囊或妊娠包块，注射MTX 50mg，β-hCG〉2000 mIU／ml的7例加用米非司酮（100mg每日2次，连续3d）联合治疗。结果治疗成功28例，成功率87．5％；4例出现急性下腹痛，经腹腔镜行输卵管切除术。注药3d后血B．hCG下降23％～35％，1周后血B．hCG下降38％～62％，2～4周后降至正常水平（≤6．1 mIU／ml），包块完全吸收30～55d。结论阴道超声引导下穿刺注射MTX治疗未破裂型早期输卵管妊娠简捷、安全、有效。对于输卵管解剖与生理功能的恢复，有待长期随访与进一步探讨。

Objective To explore the curative effect and the clinical value of transvaginal ultrasound guided methotrexate （MTX） injection for the management of unruptured early tubal pregnancy. Methods Under the guidance of transvaginal ultrasonography, needle puncture of the gestational sac or mass and MTX 50 mg injection were performed in 32 patients with unruptured early tubal pregnancy. In 7 patients with serum β -hCG 〉 2 000 mIU/ml, combined use of mifepristone （100 mg, twice daily, for 3 days） was employed. Results The treatment succeeded in 28 patients, with a success rate of 87.5%. Acute lower abdominal pain occurred in 4 patients and laparoscopic salpingectomies were carried out. The serum β - hCG levels decreased by 23% - 35% at 3 days after injection, by 38% -62% at 1 week, and to normal levels （ 46.1 mIU/ml） at 2 -4 weeks. The mass completed subsided at 30 - 55 days after injection. Conclusions Transvaginal ultrasound guided methotrexate injection for the management of unruptured early tubal pregnancy is simple, safe, and effective. Further investigations should be carried out in respect of the recovery of tubal anatomy and physiological functions.