甲氨蝶呤联合米非司酮预防腹腔镜手术后持续性异位妊娠的疗效观察

Clinical observation of efficacy of Methotrexate combining with Mifepristone prophylaxis for persistent ectopic pregnancy after laparoscopic conservative surgery

目的:探讨异位妊娠腹腔镜保守性手术后应用甲氨蝶呤联合米非司酮预防持续性异位妊娠(PEP)的疗效。方法:对108例输卵管妊娠患者行腹腔镜保守性手术后随机分成两组,观察组54例,采用甲氨蝶呤(MTX)注入患侧输卵管近端残腔,并于术后口服米非司酮;对照组54例,只采用MTX注入患侧输卵管近端残腔。所有患者均于术前及术后1、3、7、12 d检测血β-HCG值并观察毒副作用的发生情况。结果:观察组PEP发生率为1.85%,对照组为5.56%,组间有显著性差异(P<0.05);术后1 d血β-HCG值较术前明显下降(P<0.01),但两组间无显著性差异(P>0.05);术后3、7 d血β-HCG值两组间无显著性差异(P>0.05),但12 d两组间有非常显著性差异(P<0.01),观察组明显低于对照组;观察组出现的毒副作用明显多于对照组。结论:甲氨蝶呤联合米非司酮预防持续性异位妊娠(PEP)的疗效明显,与单独应用甲氨蝶呤预防相比有优势;但出现的毒副作用也明显增多,所以临床上可以选择性使用这两种方法。

Objective： To investigate the efficacy of Methotrexate combining with Mifepristone prophylaxis for persistent ectopic pregnancy after laparoscopic conservative surgery. Methods： 108 patients with tubal pregnancy who underwent laparoscopic conservative surgery were randomly divided into two groups, the treatment group （54 cases） with MTX local injection and oral Mifepristone, the control group （54 patients） with local injection of MTX alone. Serum β-HCG values were examined before and after treatment,and the occurrence of PEP and side reactions were observed. Results： The occurrence rate of PEP in treatment group and control group was 1.85% and 5.56%, there was significant difference between two groups （P〈0.05）;Serum β-HCG values dropped quickly postoperatively in all patients,the differences of serum β-HCG values in 1 day, 3 days and 7 days of post-operation were not significant between two groups （P〉0.05）. However,on the 12 day of post-operation,the serum β-HCG in treatment group was significantly lower than the control group （P〈0.01）. And the occurrence of side reactions in treatment group was greater than that in control group. Conclusion： Patients who were treated with MTX combining with Mifepristone were better than that MTX alone, but the side reactions were greater than that MTX alone. So these two methods can be selectively used in clinic.