甲氨蝶呤预防持续性宫外孕的效果观察

Clinical observation on methotrexate in preventing persistent ectopic pregnancy

目的探讨甲氨蝶呤(methotrexate,MTX)作为输卵管妊娠保守性手术辅助药物在预防持续性宫外孕(persistent ectopic pregnancy,PEP)中的临床效果。方法选择2009年12月—2011年12月收治的输卵管妊娠患者128例,随机分为对照组和观察组各64例,对照组给予保守性手术治疗,观察组在对照组的基础上给予MTX 20 mg注入患侧输卵管残腔。比较两组患者术后PEP的发生率和血β-HCG下降情况。结果 PEP发生率对照组14.1%,观察组1.6%,两组比较差异有统计学意义(P<0.05);两组术后1、3 d血β-HCG水平比较差异无统计学意义(P>0.05),术后7、12 d血β-HCG水平两组比较差异有统计学意义(P<0.05)。结论输卵管妊娠保守性手术中加用MTX可以有效预防PEP的发生,值得临床推广。

Objective To study the clinical efficacy of methotrexate in preventing ectopic pregnancy（PEP）as an adjuvant drug in conservative surgery. Methods From November 2010 to March 2012, 128 cases with PEP were randomly divided into observation group and control group, 64 cases for each. Conservative surgery was given to both groups. In addition, local injection of methotrexate into the residual cavity of affected fallopian tube was given to observation group during surgery. Serum β-HCG values and incidence of PEP were compared postoperatively in both groups. Results The incidence of PEP was 1.6% in observation group, which was significantly lower than that in control group 14.1%（P〈0.05）. Postoperative serum β-HCG values in both groups decreased significantly at different time points, and no significant difference was found in serum β-HCG values between two groups on the 1st and 3rd day after surgery（P〉0.05）. However, serum β-HCG values were significantly lower in observation group than those in control group on the 7th and 12th day after surgery（P〈0.05）. Conclusion Conservative surgery plus methotrexate is effective for preventing the occurrence of ectopic pregnancy and worthy of clinical use.