黄体剥除预防持续性异位妊娠临床分析

Clinical Study on Enucleation of Corpus Luteum to Prevent Persistent Ectopic Pregnancy

目的:观察对比黄体剥除术与甲氨喋呤(methotrexate,MTX)辅助防治输卵管妊娠腹腔镜保守性手术后持续性异位妊娠(persistent ectopic pregnancy,PEP)的疗效。方法:有生育要求的异位妊娠患者共86例,随机分成观察组44例,对照组42例。观察组腹腔镜下行胚胎清除术同时行黄体剥除术,对照组胚胎清除后局部注射甲氨碟呤20mg,未行黄体剥除。两组患者均于术前及术后24小时、72小时、7天、12天检测血β-hCG值,并观察其毒副反应。结果:观察组发生PEP1例(2.27%),对照组2例(4.76%),差异无显著性意义(χ2=0.395,P>0.05);两组术后24小时血β-hCG值较术前明显下降(P<0.01),但两组间差异无显著性意义(P>0.05);术后72小时、7天血β-hCG值两组间差异无显著性意义(P>0.05),但12天两组间比较差异有非常显著性意义,对照组明显高于观察组(P<0.01);且对照组毒副反应明显多于观察组。结论:黄体剥除术防治PEP的疗效与MTX相同,但黄体剥除术副作用小。

Objective：To compare the therapeutic efficacy of enucleation of corpus luteum to methotrexate adjuvant therapy on preventing persistent ectopie pregnancy（PEP） after laparescopic conservative operation for tubal pregnancy. Methods： Eight-six patients with ectopic pregnancy who were eager to have a baby were randomly divided to observation group （ n = 44） and control group （ n = 42 ）. Combined with laparoseopic removal of embryo, enucleation of corpus luteum was performed in the observation group and methotrexate of 20 mg was injected in the control group. The level of β-hCG was measured before operation and on day 1,3,7 and 12 after operation, and adverse events were observed. Results： The observation group had one （2.27%） case of PEP and the control group had 2 （4. 76% ） eases, with no significant difference （ X^2 = 0. 395,P 〉 0.05 ）. The level of β-hCG on the postoperative day 1 was decreased in both groups compared to that before operation （ P 〈 0.01 ）, but no significant difference between the two groups （ P 〉 0.05 ） ; no difference was noted in the level of β-hCG on the postoperative day 3 and 7 between the two groups （ P 〉 0.05 ） ; On day 12, it was markedly higher in the control group than that in the observation group（ P 〈 0.01 ）. The control group observed more adverse events. Conclusion： The therapeutic efficacy of enucleation of corpus luteum equals to MTX with less adverse effect.