血清绒毛膜促性腺激素值联合阴道流血时间对选择输卵管妊娠治疗方案的意义

Clinical implications of serum chorionic gonadotropin along with vaginal bleeding time for treatment planning for tubal pregnancy

目的探讨血清绒毛膜促性腺激素β亚基(β-HCG)值联合阴道流血时间对选择输卵管妊娠治疗方案的临床意义。方法选择我院2005年1月1日—12月31日诊断为异位妊娠的住院患者181例,根据血清β-HCG水平,分为≥128、43～127、<43 nmol/L 3组,根据阴道流血时间分为≤7 d和>7 d,最终进行输卵管妊娠治疗结果的比较。结果血清β-HCG≥128 nmol/L组中,无论阴道流血时间长短,50例(94.3%)行手术治疗,3例(5.7%)予药物保守治疗成功。血清β-HCG 43～127 nmol/L组中,27例(75.0%)行手术治疗;9例(25.0%)予药物保守治疗或期待治疗成功,而且阴道流血时间均>7 d。血清β-HCG<43 nmol/L组中,32例(34.8%)行手术治疗,60例(65.2%)予药物保守治疗或期待治疗成功,阴道流血时间>7 d 57例。结论血清β-HCG≥43 nmol/L且阴道流血时间≤7 d时,应尽量避免选择药物保守治疗;血清β-HCG 43～128 nmol/L且阴道流血时间>7 d,或β-HCG<43 nmol/L,可选择药物保守治疗或期待治疗。

Objective To explore the clinical implications of human serum chorionic gonadotropin（β-HCG） along with vaginal bleeding time for selecting the treatment approaches of tubal pregnancy. Methods Totally 181 patients with tubal pregnancy admitted between January and December, 2005, were enrolled in this study. According to serum β-HCG levels, the patients were divided into 3 groups with β-HCG level of ≥ 128 nmol/L, 43- 127 nmol/L, and 〈 43 nmol/L. The patients were also grouped on the basis of vaginal bleeding time, namely the ≤ 7 days group and 〉 7 days group. The clinical outcomes of the patients were compared between the groups following the treatments. Results Of the 53 patients with serum β-HCG level over 128 nmol/L, regardless of the vaginal bleeding time, 50（94.34 % ） were successfully managed with lateral salpingectomy and 3 （5.7 % ） with conservative therapy. In the 36 patients with serum β-HCG of 43-128 nmol/L, 27 （75%） were successfully treated with surgeries and 9（25 %） with conservative or expectant treatment, who all had a vaginal bleeding time over 7 days. In the 92 patients with serum β-HCG level lower than 43 nmol/L, 32（34.8% ）were managed surgically and 69 （65.22 %） received conservative or expectant treatment, and the majority（n= 57） of the patients had vaginal bleeding time over 7 days. Conclusion In patients with serum β-HCG over 43 nmol/L and vaginal bleeding time less than 7 days, conservative treatment with medications should be avoided for treatment of tubal pregnancy, whereas for those with β-HCG of 43-128 nmol/L and vaginal bleeding time over 7 days or with β-HCG lower than 43 nmol/L, conservative or expectant therapy is preferred.