药物保守治疗异位妊娠失败45例分析

Clinical analysis of 45 cases failure by conservative medicine treatment of ectopic pregnancy

目的通过异位妊娠保守治疗失败病例的分析,初探异位妊娠的治疗方向。方法将收住院的异位妊娠病例分两组,以1999年1月～2002年6月病例为A组,2002年7月～2005年12月为B组,药物保守治疗方案为MTX单次50mg/m2肌肉注射,最多注射2次,同时予米非司酮100mg/日,口服3天。结果治疗165例,A组药物保守治疗率18.15%,B组32.14%,两组比较p=0.0001。治疗失败45例,失败率27.27%,其中A组失败率45.61%,B组为17.59%,P<0.001,治疗失败改手术者,A组腹腔镜手术占26.92%,B组89.47%,p=0.0001。手术指征A组以腹痛+内出血为主,B组以附件包块增大为主,P<0.05。结论腹腔镜手术及药物保守治疗是目前异位妊娠治疗的趋势,药物保守治疗失败后剖腹手术或因腹腔大出血急诊手术减少。

Objective To investigate the trend of ectopic pregnancy treatment by analyzing the patients of ectopic pregnancy failure of conservative treatment. Methods 650 cases of ectopic pregnancy were divided into groupA （n=314, during Jannary 1999 to June 2002） and group B （n=336, during July 2002 to December 2005）, Atotal 165 cases were given mefepristone （with 100mg, bid, p.o.lasts 3 days） combined with injection of methotrexate（with a singie does of 50mg/m^2）. Results The conservative medicine treatment rates in group A and B were 18.15%（57/314） and 32.14%（108/336）, p=0.0001. The failure rates in group A and B were 45.61% （26/ 57） and 17.59%（19/108）, P〈0.001. The patients those failure of conservative treatment were transferred to surgery. The rate of laparoscopy was higher in group B than that in group A （89.57% versus 26.92%）. The surgical indications of group A were abdominal pain＋intraabdominal blood loss mainly. That in group B were ectopic mass increase mainly. P〈0.05. Conclusion The patients of ectopic pregnancy were detected at an earlier stage and possible to be treated more conservatively and laparoscopy, laparotome and emergency operation reduce after failure of conservative medicine treatment.