不同水平β-HCG的异位妊娠采用药物保守治疗与腹腔镜保守手术的疗效分析

Efficacy of drug conservative treatment and laparoscopic conservative surgery for ectopic pregnancy with different levels of beta-HCG

目的探讨不同水平β-HCG异位妊娠患者采用药物保守治疗与腹腔镜保守手术的疗效。方法收集2010年1月至2015年12月期间,揭阳市人民医院妇科收治的450例异位妊娠患者,采用腹腔镜保守手术250例,设为A组;采用甲氨蝶呤(MTX)肌肉注射联合米非司酮口服药物保守治疗200例(B组)。观察两组不同β-HCG水平患者治疗后β-HCG降至正常的时间、治疗后三个月输卵管通畅率及治疗后六个月宫内妊娠率。结果 A组手术都获得成功,术中均保留患侧输卵管,无中转开腹手术的患者。治疗后β-HCG降至正常的时间,A组的低、中和高水平组均分别明显少于B组(P<0.05),且β-HCG水平越低时间越短。治疗后三个月输卵管通畅率A组高于B组,两组比较差异均有统计学意义(P<0.05),β-HCG水平越低通畅率越高(P<0.05)。治疗后六个月宫内妊娠率A组低、中水平组均显著高于B组(P<0.05)。结论腹腔镜在异位妊娠的治疗过程中起到重大的作用,特别是对于β-HCG呈中低水平的患者,能显著提高妊娠率,是一种值得推荐的治疗方法。

Objective To explore the efficacy of drug or laparoseopic surgery with ectopie pregnancy with different levels of β-HCG. Methods From January 2010 to December 2015, 450 patients with ectopic pregnancy from Jieyang People＇s Hospital were divided into two groups： 250 cases in Laparoscopie group （A） and 200 cases in the group of conservative treatment which used methotrexate （MTX） intramuscular injection and mifepristone ora. Compared the time of β-HCG declining to normal, tubal patency rate after treatment 3 months, intrauterine pregnancy rate after 6 months between the two groups. Results All operations of Group A were successful, of which were reserved ipsilateral fallopian tube, and none of them changed to open surgery. The time of β-HCG dropping to normal in group A with different concentration was significantly shorter than group B （P〈0.05）, and the time was shorter in the patients with low level of β-HCG （P〈0.05）. The difference of tubal pateney rate in group A and group B after three months was statistically significant （P〈0.05） and the tubal patency rate was more higher in the patients with low concentration of β-HCG （P〈0.05）. The intrauterine pregnancy rate in group A was significantly higher than group B （P 〈 0. 05 ）, except for the patients with high concentration of β-HCG. Conclusions Laparoseopic play a major role in the treatment of ectopic pregnancy, especially for the patients of low level of β-HCG, which can significantly improve the pregnancy rate, and it is a treatment method which worth recommendation.