超声引导下甲氨蝶呤局部注射联合米非司酮治疗未破裂型输卵管妊娠

Ultrasound-guided Local Injection of MTX Combined with Mifepristone for Unruptured Tubal Pregnancy

目的：探讨超声引导下甲氨蝶呤（methotrexate，MTX）局部注射联合米非司酮治疗未破裂型输卵管妊娠的疗效。方法2013年1月～2014年2月对120例未破裂型输卵管妊娠，在 B 超引导下在未破裂型输卵管妊娠囊内注射 MTX 1 mg ／kg，同时口服米非司酮75 mg，2次／d，共4 d。结果超声引导下112例1次穿刺成功，8例2次穿刺成功。80例（66．7％）治疗后第4天β-hCG 下降＞15％，10例（8．3％）无明显变化，30例（25．0％）上升，但＜15％。105例治疗后第7天β-hCG 下降＞15％，治疗后第14天进一步下降，1个月后降为阴性，腹痛明显缓解至消失，阴道流血停止，包块缩小或消失，治疗成功率87．5％（105／120）。住院费用1208．5～2722．6元，平均1859．4元。余15例腹腔镜手术治疗。结论超声引导下MTX 局部注射联合米非司酮治疗未破裂型输卵管妊娠简便、安全。

Objective To study the therapeutic effect of ultrasonic guidance MTX local injection combined with mifepristone in the treatment of unruptured tubal pregnancy. Methods From January 2013 to February 2014,a total of 120 cases of unruptured tubal pregnancy were given injection of MTX 1 mg /kg in the capsule under ultrasonic guidance and oral administration of mifepristone 75 mg twice a day for 4 days. Results Ultrasound-guided puncture was successfully completed at first time in 1 12 cases and at second time in 8 cases.Four days after treatment,the β-hCG decreased by more than 15% in 80 cases （66.7%）,had no significant change in 10 cases （8.3%）,and increased by less than 15% in 30 cases （25.0%）.The β-hCG decreased by more than 15% at the seventh day in 105 cases （87.5%）,and had a further decline at the 14th day,and dropped to normal after a month,with abdominal pain relieved,vaginal bleeding stopped,and abdominal mass shrunk or disappeared.The treatment successful rate was 87.5%（105 /120）.The hospitalization costs was 1208.5 -2722.6 yuan,with an average of 1859.4 yuan. Conclusion Under ultrasonic guidance,MTX local injection combined with mifepristone in the treatment of unruptured tubal pregnancy is a simple and safe method.