3种治疗方法对输卵管妊娠患者预后影响的临床分析

Clinical analysis on the effect of three treatment of tubal pregnancy on the prognosis

目的:分析评价药物治疗、保守性和根治性手术治疗输卵管妊娠对患者预后的影响。方法:回顾性分析149例有生育要求的异位妊娠患者的临床资料,其中54例患者采用氨甲喋呤(MTX)和米非司酮(MST)联合治疗(药物组),即给予MTX 50 mg加30 ml生理盐水隔日静注,隔日用15 mg四氢叶酸钙(CF)肌注解毒,同时口服50 mg MST;51例行输卵管保守性手术治疗(保守手术组),44例行患侧输卵管切除术(根治手术组)。结果:药物组经过1或2个疗程治疗后,治愈35例,治愈率为64.8%,无效或因其他原因而改为手术治疗的19例。保守和根治手术组治愈率均为100%。追踪随访24个月,3组再次异位妊娠发生率保守性手术组最高(16.7%),药物组(4.3%)次之,根治手术组(2.6%)最低;3组的宫内妊娠率差异无统计学意义(药物组53.2%,保守手术组40.5%,根治手术组53.8%,χ2=1.91,P>0.05)。结论:药物治疗未破裂型输卵管妊娠的再次异位妊娠发生率较低,再次宫内妊娠率与手术组差异无统计学意义,是一种安全、有效的治疗措施。

Objective：To analyze the fertility prognosis after medical treatment,conservative or radical surgery for tubal pregnancy.Methods：The clinical and follow-up data of 149 patients with tubal pregnancy were analysed retrospectively.54 cases were treated with methotrexate and mifepristone（Group A）,51 cases were treated by conservative surgery（Group B） and 44 cases were treated by radical surgery（Group C）.Results：The cure rates of Group A,Group B and Group C were 64.8%,100% and 100%,respectively.After two years follow-up survey,the repeat ectopic pregnancy rate in Group B（16.7%） was significantly higher than those in Group A（4.3%） and Group C（2.6%）,but there was no significant difference in the intrauterine pregnancy rate between three groups（χ^2=1.91,P〉0.05）.Conclusion：The combination of methotrexate and mifepristone in the treatment of tubal pregnancy,which has lower repeat ectopic pregnancy rate and similar intrauterine pregnancy rate with conservative or radical surgery,is a safe and effective means.