甲氨蝶呤联合米非司酮辅助腹腔镜胚胎吸出术治疗异位妊娠的疗效及对患者性生活质量的影响

Curative effect of methotrexate combined with mifepristone assisted laparoscopic embryo aspiration in the treatment of ectopic pregnancy and its effect on the quality of sexual life of patients

目的探讨腹腔镜胚胎吸出术前肌注甲氨蝶呤(MTX)联合术后服用米非司酮(MFP)治疗异位妊娠(EP)的疗效及对其性生活质量的影响。方法采用随机抽签法将符合纳入标准的144例患者分为对照组和试验组,每组72例。纳入者均选择腹腔镜胚胎吸出术进行治疗,同时对照组术后口服MFP,试验组术前局部肌注MTX,术后口服MFP。对比两组手术时间、住院时间、包块消失时间、输卵管通畅率及PEP发生率;比较两组术后14 dβ-HCG水平及术后1年性生活质量和再妊娠率。结果与对照组相比,试验组手术时间、住院时间及包块消失时间均明显更短,术后输卵管通畅率明显更高,PEP发生率更低(P<0.05);术后14 d试验组血清β-HCG水平低于对照组(P<0.05);术后随访1年,试验组患者性生活频率、性唤起时间、高潮时间、性生活满意度评分及再妊娠率均优于对照组(P<0.05)。结论腹腔镜胚胎吸出术中,术前肌注MTX联合术后服用MFP治疗EP效果显著,可有效促进输卵管通畅,控制PEP发生率,提高患者性生活质量。

Objective To investigate the effect of methotrexate（MTX） combined with mifepristone（MFP） in ectopic pregnancy（EP） before laparoscopic embryo aspiration and its effect on the quality of sexual life. Methods A total of 144 patients met the inclusion criteria were divided into control group and experimental group by the random drawing method.Laparoscopic embryo aspiration was selected for treatment, and the control group was treated with MFP oral after surgery;and the experimental group was treated with MTX injection before surgery and MFP oral after surgery. The operative time,hospitalization time, packet loss time, the patent rate of tubal, incidences of PEP, the levels of β-HCG at 14 d after operation, the quality of sexual life and repregnancy rate of one year after surgery were compared between the two groups.Results Compared with the control group, the operative time, hospitalization time, packet loss time in the experimental group were significantly shorter, postoperative the patent rate of tubal was higher, and the incidence of PEP was lower（P〈0.05）; the level of serum β-HCG in the experimental group was lower than that of the control group at 14 d after surgery（P〈0.05）; and follow up for one year after surgery, the frequency of sexual life, the time of sexual arousal, the duration of orgasm, the score of sexual life satisfaction and repregnancy rate in the experimental group were better than those of the control group（P〈0.05）. Conclusion In laparoscopic embryo aspiration, preoperative intramuscular injection of MTX combined with postoperative administration of MFP in EP has a significant effect, which can effectively promote tubal patency, control the incidence of PEP and improve the quality of sexual life of patients.