肌肉注射氨甲喋呤治疗输卵管妊娠的观察

Observation on Treating Tubal Pregnancy Using Methotrexate Intramuscular Injection

目的 :探讨氨甲喋呤 (MTX)肌肉注射治疗输卵管妊娠的效果及适应症。方法 :对 2 8例确诊为输卵管妊娠患者采用MTX肌肉注射 (2 0mg/d ,5d为 1个疗程 ) ,定时监测血 β HCG直至正常。结果 :2 5例一次杀胚成功 ,2例经MTX治疗一个疗程 ,血 β HCG未降至正常 ,加用米非司酮 (RU486 )口服 (5 0mg/d) ,分二次 ,3d为 1个疗程 ) ,杀胚成功 ,有效率为 89.3% ,仅 1例二次杀胚不成功行手术治疗。成功与失败患者的孕龄、异位妊娠包块直径间的差异无显著性 (P >0 .0 5 ) ,但治疗前腹痛症状的发生率及血 β -HCG值间的差异有非常显著性 (P <0 .0 1)。结论 :早期诊断和严格选择病例是治疗成功的关键。无腹痛症状 ,异位妊娠包块直径≤ 3cm ,血 β HCG值 <30 0

Objcective: The efficacy and indication of intramuscular injection of methotrexate(MTX) to treat early tubal pregnancy were explored.Methods: 28 cases of tubal pregnancy were treated by intramuscular injection of MTX(20 mg/d,five days are one course).The β HCG was monitored regularly till it became normal.Results:25 cases were successful in first treatment by MTX,2 cases were not satisfactory in one course treatment by MTX,later by taking orally mifepristore(RU486) (50 mg/d,divided into two havlas,three days are one course)were successful.The effective rate is 89.3%.Only one patient was operated for MTX failed.There were no significant differences( P >0.05)in gestational age and size of adnexa ectopic mass between successful cases and failed cases,but highly significant differences( P <0.01)in occurrence rate of abdominal pain and β HCG titers before treatment.Conclusion: The early diagnosis and adherence to strict criteria are the keys to successful mangement.No abdominal pain and titer of serum β HCG<3000 IU/L were mainly indications of drug treatmetn.