不同剂量甲氨蝶呤联合腹腔镜手术治疗宫外孕的临床研究

Clinical study on treating ectopic pregnancy with laparoscopic combined with different dose of methotrexate

目的:探讨甲氨蝶呤(MTX)联合腹腔镜手术治疗宫外孕的有效剂量,为治疗宫外孕提供参考。方法:将165例宫外孕患者随机分为低剂量组(n=56,采用MTX 25 mg联合腹腔镜治疗)、中剂量组(n=59,采用MTX 50 mg联合腹腔镜治疗)、高剂量组(n=50,采用MTX 100 mg联合腹腔镜治疗),比较3组术前与术后3、7、14 d的血β-HCG水平及恢复正常的时间,随访2年内宫内妊娠率及持续异位妊娠(PEP)的发生率。结果:中剂量组术后3、7、14 d血β-HCG水平明显低于低剂量组,且恢复正常的时间明显缩短;高剂量组术后3、7、14 d血β-HCG水平明显低于低剂量组和中剂量组,且恢复正常的时间较其他两组也明显缩短。3组术后随访2年,PEP及术后1年宫内妊娠率差异无统计学意义(均P>0.05);高剂量组、中剂量组术后2年宫内妊娠率明显高于低剂量组(均P<0.05)。3组不良反应发生率比较差异有统计学意义(P<0.05),且高剂量组明显高于中剂量组和低剂量组,但中剂量组与低剂量组间差异不明显(P>0.05)。结论:腹腔镜手术联合中等剂量MTX治疗宫外孕能更有效地提高临床疗效,安全性较好。

Objective ： To investigate the effective dose of methotrexate combined with laparoscopy in treatment of ectopic pregnancy and proved reference for the clinical treatment of ectopic pregnancy. Methods： One hundred sixteen-five cases of patients with ectopie pregnancy were divided into low dose group （n = 56, MTX 25 mg combined with laparoscopic conservative operation; middle dose group （n = 59, MTX 50 mg combined with laparoscopic conservative operation ） ; high dose group （ n = 50, MTX 100 mg combined with laparoscopic conservative operation. The serum β-HCG level at before treatment, third day, seventh day, fourteenth day after treatment and the recovery time of serum β-HCG were compeared among the 3 groups. Persistent eetopic pregnancy （PEP） rate and intrauterine pregnancy rate within two years of the treatment were followed-up. Results： The levels of serum fl-HCG at postoperative third day, seventh day, fourteenth day in middle dose group were significantly lower than those in low dose group, serum fl-HCG level recovery time was significantly shorter. The levels of serum β-HCG at postoperative third day, seventh day, fourteenth day in high dose group were significantly lower than those in low dose group and middle dose group, serum β-HCG level recovery time was shorter than the other two groups. In the Followed- up of 2 years, the difference of PEP rate and one year intrauterine pregnancy rate in three groups was not statistically significant （ P 〉 0.05 ）. The intrauterine pregnancy rate in high dose group or middle dose group was significantly higher than that of low dose group （ P 〈 0.05 ）. Adverse reaction incidence among three groups had statistically significant difference （P 〈 0.05 ） while high dose group was significantly higher than that in middle dose group or low dose group, but there was no obvious difference between in middle dose group and in low dose group （ P 〉 0.05 ）. Conclusion： Treating ectopie pregnancy with laparoscopic operation combined with middle doses of MTX can effectively improve clinical efficacy, its security is good, it is worthy of clinical referen.