介入治疗输卵管妊娠的初步探讨

Preliminary study of interventional treatment for tubal pregnancy

目的 探讨介入治疗输卵管妊娠的临床价值和治疗途径。方法 分析 2种介入途径治疗的 18例输卵管妊娠患者 ,其中 8例为经阴道输卵管插管孕囊内注射氨甲喋呤 (MTX) ,10例为经子宫动脉插管灌注MTX +栓塞 ,选用Cook公司双球囊输卵管再通装置和 4.1FrCobra导管。术后以患者症状、体征、β HCG水平及孕囊的B超值的动态变化作为疗效的监测指标。 结果 18例总插管成功率、治愈率、杀胚率分别为 10 0 %、88.9% (16 / 18)、94.4% (17/ 18) ,2例经阴道途径治疗失败。尿 β HCG下降至正常 (3～ 2 8d)平均 (11.2± 11.6 )d ,B超示孕囊在治疗后 2～ 3周内消失 10例 ,占 76 .9% (10 / 13) ,最长 6 0d消失 ,恢复正常月经平均 (37± 9)d(2 1～ 5 0d)。结论 介入治疗输卵管妊娠疗效可靠 ,操作简便 ,尤其经动脉途径更有价值 ,介入治疗应成为终止输卵管妊娠的重要手段。

Objective To study the clinical value and methods of interventional treatment for tubal pregnancy. Methods Two different methods were used in the interventional treatment of 18 patients with tubal pregnancy, which were transvaginal tubal intra gestational methotrexate (MTX) injection and intra uterinoarterial MTX infusion. The former was selected for the treatment of 8 patients and the latter for 10 patients. Cook falliopion tube catheterization set and the general angiographic catheters of 4.1 Fr Cobra were used. After the treatment, conditions of the patients, β HCG level and ultrasound changes of the pregnant bladder were the main indexes for monitoring the therapeutic effect in this study. Results The successfu rate, cure rate, embryo killing rate reached 100%, 88.9% (16/18) and 94.4%(17/18) respectively. Two cases of intra uterinoarterial MTX infusion treatment failed. β HCG was reduced to normal level with an average of 11.2±11.6d(3～28d). In 10 cases, the ultrasound showed that the pregnancy bladder disappeared in 2～3 weeks, accounting for 76.9%(10/13). The longest time was 60 days. The range of menstruation recovery was 37±9 d(21～50 d). Conclusions Interventional treatment of tubal pregnancy is effective, reliable and easy for operation. It will be especially effective by arterial procedure. Interventional treatment will be an important method for terminating tubal pregnancy.