前列腺素与氨甲喋呤预防腹腔镜手术后持续性异位妊娠的疗效对比

Comparison of prostaglandin and MTX in prevention of persistent ectopic pregnancy after laparoscopic salpingostomy

目的比较前列腺素与氨甲喋呤预防腹腔镜保守性手术后持续异位妊娠(PEP)的临床疗效。方法将150例输卵管妊娠行腹腔镜保守手术患者随机分成三组,治疗组60例,术毕予前列腺素F2α注射液600μg注入患侧输卵管残腔;对照组60例,术毕予氨甲蝶呤注射液20 mg注入患侧输卵管残腔注射;开放组30例,术毕不用任何药物。所有患者均于术前及术后第1天、第3天、第7天检测血β-HCG及孕酮值。结果 150例异位妊娠患者中有11例术后再次发生PEP,总发生率为7.33%。治疗组PEP发生率为1.67%(1/60);对照组PEP发生率为5.00%(3/60);开放组PEP发生率为23.33%(7/30)。三组比较,治疗组、对照组的PEP发生率显著低于开放组(P均<0.01),治疗组与对照组的PEP发生率无显著性差异(P>0.05)。治疗后1、3、7 d三组β-HCG值及孕酮含量均显著下降,并且后一时段与前一时段相比有逐级下降趋势(P均<0.01),治疗组、对照组下降幅度大于开放组,治疗组又大于对照组(P<0.05或0.01)。对照组不良反应发生率为5.0%(3/60),治疗组无一例发生不良反应。结论前列腺素预防腹腔镜保守性手术后持续异位妊娠的效果优于氨甲蝶呤,且安全无毒副作用。

Objective To evaluate the effect of prostaglandin and methotrexate（MTX） in prevention of persistent ectopic pregnancy（PEP） after laparoscopic salpingostomy.Methods 150 patients with ectopic pregnancy were randomly divided into three groups.60 cases were in treatment group：prostaglandin was injected into the affected side fallopian tube lumen after laparoscopic salpingostomy;60 cases were in control group：MTX was injected in the same way;30 cases were in patulous group.Serum β-HCG and progesterone were tested for four times： before the operation,the first,third and a week after the operation respectively.Results There were 11 patients of PEP in this study,one patient in treatment group,three patients in control group,the rest seven patients in patulous group.The incidence of PEP was not statistically significant between treatment group and control group（P0.05）.While the difference was significant between treatment group and patulous group（P0.05）.Serum β-HCG and progesterone in three groups descended significantly in the first 24 hours after operation,As for the descending of β-HCG and progesterone in day 3 and 7,that of β-HCG and progesterone was lower than control group and patulous group.Untoward effects incidence rate in control group was 5.0%（3/60）but none in the treatment group.Conclusion Prostaglandin is an effective and safer method to prevent persistent ectopic pregnancy after laparoscopic salpingostomy.