输卵管妊娠腹腔镜保守手术后甲氨蝶呤局部给药与肌肉注射的疗效比较

Effect of topical use and muscle injection of methotrexate in tubal pregnancy after laparoscopic conservative surgery

目的观察输卵管妊娠腹腔镜下行保守手术后甲氨蝶呤局部给药与肌肉注射的疗效。方法将2011年3月至2013年12月期间我院接受腹腔镜手术治疗的未破裂输卵管妊娠患者80例纳入研究对象,进行输卵管开窗取胚手术,并随机分为腹腔镜下局部给药(观察组)与肌肉注射(对照组)两种甲氨蝶呤给药途径,比较两组患者术后的血清β-HCG水平、并发症发生率以及生活质量。结果术后3d、5d、7d时,观察组患者的血清β-HCG水平(分别为414.6±55.2、205.9±31.8、79.1±9.5U/L)明显低于对照组(分别为741.5±100.1、552.8±65.2、215.7±31.5U/L)(P<0.05);发生持续性异位妊娠、恶心呕吐、肝、肾功能损害明显少于对照组(P<0.05);社会功能、情绪功能、精神健康等生活质量评分(分别为74.2±10.8、68.4±8.1、66.0±9.2)明显高于对照组(分别为63.8±8.6、57.9±7.5、56.6±8.6)(P<0.05)。结论腹腔镜下甲氨蝶呤局部注射能够彻底杀灭滋养层细胞、预防持续性异位妊娠的发生,同时减少肝肾功能损害,并提高了生活质量,是输卵管妊娠保守手术的理想辅助治疗措施。

Objective： To observe the effect of topical use and muscle injection of methotrexate in patients with tubal pregnancy after laparoscopic conservative surgery. Methods： The patients with unruptured tubal pregnancy who received laparoscopic surgery in our hospital from March 2011 to December 2013 were enrolled and divided into observation group（topical use of methotrexate）and control group（intramuscular injection of methotrexate）. Then serum ^-HCG levels, complications rate and quality of life were compared between the two groups. Results： The serum β-HCG levels at 3,5 and 7 days after surgery in the patients of observation group （414.6±55.2,205.9±31.8,79.1±9.5 U/L） were significantly lower than those in control group（741.5 ±100.1,552.8±65.2,215.7± 31.5 U/L） （P〈0.05）. The incidences of persistent ectopic pregnancy, nausea and vomiting,renal or liver function damage were significantly lower than those in control group（P 〈0.05）. The scores of life quality in social function,emotional function,mental health were significantly higher than those in controlgroup（74.2±10.8 vs. 63.8±8.6,68.4±8.1 vs. 57.9±7.5,66.0±9.2 vs. 56.6 ±8.6, respectively） （P〈0.05）. Conclusions： Topical use of methotrexate by laparoscope is an ideal method in treatment of unruptured tubal pregnancy, which can thoroughly eliminate the trophoblast cells, prevent persistent ectopic pregnancy,reduce target organ damage,and improve the quality of life.