MTX预防持续性异位妊娠的分析

An Analysis of MTX in Prevention of Persistent Ectopic Pregnancy

目的:探讨甲氨蝶呤(MTX)不同剂量作为输卵管妊娠腹腔镜保守手术辅助药物来预防持续性异位妊娠(PEP)的作用。方法:将170例行腹腔镜保守治疗输卵管妊娠未破裂患者随机分成两组,病灶残腔注射MTX 20 mg组96例为观察1组,病灶残腔注射MTX 10 mg组74例为观察2组。结果:170例患者中有4例发生PEP,发生率为2.35%。异位妊娠保守性手术中预防性应用MTX 10 mg后PEP发生率为2.7%,而20 mg组PEP发生率为2.1%,两组发生率差异无显著性(P>0.05)。术后第1天两组血-βHCG均有大幅度下降,术后1、3、12天血-βHCG下降两治疗组间差异无显著性(P>0.05)。术后第1天PEP组血清-βHCG下降率低于50%,与非PEP组下降率比较,差异无显著性(P>0.05),术后3、12天PEP组血清-βHCG下降率明显低于非PEP组(P<0.05)。结论:输卵管妊娠保守性手术的同时,绒毛种植部位注射MTX可降低PEP率。两剂量均可用于PEP的预防。

Objective：To study the therapeutic effect of MTX with different dosage to prevent persistent ectopic pregnancy after conservatively laparoecopic operation, Methods： 170 ectopic pregnancy patients were divided into two groups randomly.The test group has74 cases,while the control group has 96 cases.20 mg of MTX was injected into fallopian tube lumen in the control group,while in the test group only 10 mg of MTX was injected. Results： There were4 cases of PEP in 170 cases.The incidence among all 170 cases was 2.35%,while in the test group of 74 cases 2.7%, and in the control group of 96 cases 2.1%. The difference was not statistically significant （ P 〉 0.05）. Serum β-HCG in both groups descended significantly in the first 24 hours after operation, and the difference had no statistical significance between two groups at 1day,3 day and 12 day after operation respectively （ P〉 0.05） .The HCG descending rate in PEP group was less than 50% in 1 day after operation. There was significant difference of descending rate of serum β-HCG at 3 day and 12 day after operation between PEP group and non-PEP group （ P〈 0.05） .Conclusions：Local injection of MTX with both 10 mg or 20 mg dosage during salpingostomy can decrease the risk of persistent ectopic pregnancy.