不同保守方法治疗输卵管妊娠的临床研究

Clinical Effect of Different Conservative Treatment Tubal Pregnancy

目的通过监测血β-HCG的变化来探讨不同保守方法治疗输卵管妊娠临床疗效。方法回顾性分析保守治疗输卵管妊娠47例，其中药物治疗组15例（A组），保守性手术加术中输卵管局部注射甲氨蝶呤（MTX）20mg组20例（B组），单纯保守手术组12例（C组）。治疗后定期监测β-HCG。结果A组有14例治疗成功，另1例因治疗后血β-HCG明显升高，并出现腹痛而中转手术治疗；B组20例均治愈；C组12例成功，1例发生持续输卵管妊娠。B组术后血β-HCG下降至正常时间明显短于A组和C组。术前血β-HCG浓度高者，术后降至正常所需要时间长，但在A组则无明显相关性。结论输卵管妊娠保守性治疗后监测血β-HCG极为重要，手术中采用输卵管局部注射MTX可加快术后血β-HCG的下降速度。

Objective To obse we the Curative effect of different conservative treatment for tubal pregnancy by serum β- HCG levels. Methods vsing a retrospective cohort, we collected AT cases that received conservative treatment for tubal pregnancy, including 15 cases treated with drags alone （group A） ,20 women consevative surgery with fallopian local injection of MTX 20mg （group B）, and 12 treated with conservative surgery alone （ group C）, The levels of serub β-HCG wer surveilled every three days after conservative treatment antil serum β- HCG titers retumed to normal. Results 15 cases in group A were cured completely, exceptl case with serum β- HCG enhanced. All 20 case of group B and 12 cases of group C bealet levels was significantly shorter in group B than in group C and gourp A. the higher preoperative serum β- HCG titers related with longer time that drop to normal , but no correlation in group A. Conclusions consecutive surveillance of serum β- HCG titers after conservative treatment is very important. Fallopian local injection of MTX during consevative surgery may accelerate the decline of postoperative seram β- HCG concentration.