156例输卵管妊娠保守治疗的临床分析

Medical Treatment of 156 Cases of Unruptured Tubal Ectopic Pregnancy

目的观察输卵管妊娠保守治疗的效果,分析保守治疗成功的相关因素。方法回顾性分析输卵管妊娠患者156例,均接受甲氨蝶呤(MTX)50mg单次注射配合米非司酮25mg每日两次口服,连续治疗3d,根据治疗结果分为治疗成功组123例,治疗失败组33例,同期选择40例宫内早孕妇女40例作为对照组。记录3组一般资料,包括年龄、月经周期、停经天数、孕次、产次及βHCG水平。所有输卵管妊娠患者,均记录其临床表现,包括有无腹痛、阴道流血、B超显示包块大小及盆腔积液情况,并观察药物治疗前后βHCG的变化状况。结果一般资料显示,3组间βHCG水平差异有统计学意义,βHCG水平以正常早孕组最高(P<0.05)。临床表现方面,治疗成功组与治疗失败组的腹痛天数、阴道流血天数无统计学差异,B超检查包块大小及盆腔积液情况有差异,包块<1cm治疗成功组12例,治疗失败组1例;包块1～3cm治疗成功组96例,治疗失败组23例;包块>3cm治疗成功组15例,治疗失败组9例。盆腔积液<1cm治疗成功组53例,治疗失败组10例;1～3cm治疗成功组49例,治疗失败组12例;>3cm治疗成功组21例,治疗失败组11例。βHCG水平,治疗成功组<1500mIU/ml的有85.4%,高于治疗失败组的39.4%(P<0.05);1500～6000mIU/ml的有11.4%,低于治疗失败组的45.5%(P<0.05);>6000mIU/ml的占3.2%,与治疗失败组的4.1%接近。治疗成功组用药3d后βHCG下降>15%的有81.3%,而治疗失败组仅为10.6%(P<0.05)。结论输卵管妊娠B超检查包块>3cm和(或)盆腔积液>3cm保守治疗不易成功,βHCG水平高的患者,保守治疗有一定的成功率,但失败的风险较高,治疗过程中需予以重视。而药物治疗3d后βHCG下降<15%,则提示需及时改用手术等其他治疗方式。

Objective To evaluate the effect of conservative treatment of ectopic pregnancy.Methods Retrospective analysis of 156 cases of conservative treatment in unruptured tubal ectopic pregnancy patients with methotrexate（MTX,50 mg） and Mifepristone（25 mg） was performed.40 cases of normal early pregnant women were chosen as control group.According to the treatment outcomes,123 cases were considered as successfully treated and 33 cases were considered as treatment failure.Information collected for analysis included the age,menopause,days of pregnant,motherhood times,HCG level,abdominal pain,vaginal bleeding,mass diameter,intra-abdominal fluid diameter and the changing of βHCG before and after treatment.Results The level of βHCG in the control group was significantly higher than those of tubal pregnant patients（P 〈0.05）.There were no differences in the clinical characteristics among patients with abdominal pain and vaginal bleeding.There was a great difference in mass diameter and intra-abdominal fluid diameter：12 cases of mass size1 cm in the successfully treatment group,only 1 case in the treatment failure group;96 cases of mass size 1～3 cm in the successfully treatment group,only 23 cases in the failure group（P〉0.05）.And 53 cases of fluid diameter 1 cm in the successfully treatment group,only 10 cases in the treatment failure group,49 cases of mass size 1～3 cm in the successfully treatment group and 12 cases in the treatment failure group（P〈0.05）.85.4% patients in the treatment successful group had βHCG 〈1 500 mIU /ml;and the percentage was greater than the treatment failure group.11.4% patients in the treatment successful group had βHCG between 1 500～6 000 mIU/ml;and the percentage was lower than the treatment failure group（P〈0.05）.Compared with the treatment failure group（10.6%）,81.3% of patients in the treatment successful group had a reduction of βHCG 〉15% at 3 days of treatment.Conclusions Methotrexate and oral mifepristone therapy is an effective method for the treatment of early un-ruptured tubal pregnancy.When there are some signs such as mass size〉 3 cm,fluid diameter 〉3 cm and HCG decreased 〈15%,the risk of failure is high and other methods may be required for the treatment.