腹腔镜保守手术和甲氨蝶呤联合米非司酮治疗异位妊娠的临床研究

Clinical Research of Patient with Ectopic Pregnancy Treated by Laparoscopic Conservative Surgery and Methotrexate combined with Mifepristone

目的:探讨腹腔镜保守手术和甲氨蝶呤联合米非司酮治疗异位妊娠的临床疗效及应用价值。方法:将2011年1月至2013年11月在我院确诊的并可行保守治疗的70例异位妊娠患者随机分为对照组(n=34)和研究组(n=36),分别以甲氨蝶呤联合米非司酮治疗和采用腹腔镜保守手术,治愈后4个月行宫腔输卵管碘油造影检查。比较两组的疗效、住院情况及输卵管复通率。结果:两组均治愈,研究组输卵管复通率明显高于对照组(86.11%vs 64.70%,P<0.05),住院费用显著高于对照组(7823.08±263.15元v8 3869.46±195.26元,P<0.05),住院时间显著短于对照组(7.18±0.93 d vs 22.45±6.51 d,P<0.05)。研究组胃肠道反应发生率低于对照组。结论:两种方法均能取得较好疗效,甲氨蝶呤联合米非司酮治疗费用低,患者无手术风险;腹腔镜保守手术治疗有较高的输卵管复通率及较少的住院天数;胃肠道反应发生率低,更有利于恢复患者的输卵管通畅。

Objective： To explore the clinical effect and application value of laparoscopic conservative surgery and methotrexate combined with mifepristone for patients with ectopic pregnancy. Methods： 70 patients with eetopic pregnancy diagnosed and met the conservative treatment conditions from Jan 2011 to Nov 2013 were randomly divided into control group （n=34） and study group （n=36） were treated by methotrexate combined with mifepristone and laparoseopic conservative surgery, respectively. The uterine hysterosalpingography examination was given after treatment 4 months. The efficacy, hospitalizations and the tubal reeanalization rate were compared between the two groups. Results：All the patients in the two groups cured. The tubal recanalization rate and the hospitalization cost in the study group were significantly higher than those in the control group （86.11% vs 64.70%, 7823.08±263.15 Yuan vs 3869.46±195.26 Yuan,both P〈0.05）. The duration of hospital stays in the study group was significantly shorter than that in the control group（7.18 ± 0.93 days vs 22.45±6.51 days,P〈0.05）. The occurrences of gastrointestinal reactions in the study group were significantly lower than those in the control group. Conclusion： Both methods can achieve better results for patients with ectopic pregnancy. Methotrexate combined with mifepristone costs less without surgical risk, laparoscopic conservative has higher tubal recanalization rates and shorter hospital stays, and lower occurrences of gastrointestinal reactions than the method of methotrexate combined with mifepfistone, which is more conducive to restoring patient＇s tubal patency.