四种方法治疗异位妊娠207例分析

DIFFERENT TREATMENTS FOR TUBAL PREGNANCY:A REPORT OF 207 CASES FOR 4 THERAPIES

目的探讨治疗不同类型异位妊娠的适宜治疗方法。方法本院在2006年12月—2008年12月诊断异位妊娠并住院患者共207例,根据患者入院时的自觉症状,生命体征情况,血hCG结果,B超测量附件区包块大小分成四组。采用四种不同治疗方案即开腹手术、腔镜手术、注射MTX、口服米非司酮;衡量治疗方法的标准根据每种方法是否需要二次治疗、血hCG转阴天数以及住院天数。结果开腹手术35例(17%),腹腔镜手术112例(54%),注射MTX33例(16%),口服米非司酮27例(13%)。所有的开腹手术患者不需要进一步的随访。开腹手术和腔镜手术的147例之中的146例均痊愈,只有1例行腔镜下切开取胚术后因持续性宫外孕需要二次开腹手术,注射MTX的33例中有25例不再需要进一步的治疗,另外2例需二次注射MTX,另有6例(18%)因服药后自觉腹痛明显或者有内出血征象而行腹腔镜手术。口服米非司酮组27例,其中有4例(15%)因中途腹痛明显或者有内出血征象而行腹腔镜手术。剖腹手术、腔镜手术、注射MTX、口服米非司酮治疗住院天数分别为8.0、4.5、14.5、15d,血hCG转阴时间为7.5、7.2、14.5、12d。结论宫外孕患者中接近1/6的有剧烈腹痛病史的患者需要紧急手术,大约29%的患者可以用非手术方案治疗,根据病情选择适宜的治疗方案会取得良好的临床效果。

Objective To evaluate the appropriate treatment of tubal pregnancy. Methods From Dec 2006 to Dec 2008, there were 207 cases with tubal pregnancy treated in my hospital. A crosssectional analytical study was done. Four modes of treatment were given according to patient＇s condition, ultrasound findings and β- hCG levels; these were laparotomy, operative laparoscopy, methotrexate injection and take orally management. The outcome measures included success of each treatment modality, need for second mode of treatment in each group and duration of hospital stay. Resuits Emergency laparotomy was performed in 35 （17%） women, operative laparoscopy in 112 （54%）, methotrexate injection in 33 （16 % ） and RU486 medicine in 27 （13%）. The hospitalization days of laparotomy, laparoscopy, methtrexate injection, take RU486 Group was 8.0, 4. 5, 14. 5 and 15; days of blood HCG turning into negtive were 7. 5, 7.2, 14. 5 and 12. Conclusion Almost 1/6 of all women with ectopic pregnancy presented with acute abdomen pain and required emergency laparotomy. About 29% women could be managed with non- surgical modalities. To select the indications and contraindieation striekly and to choose appropriate treatment can result in good outcome.