腹腔镜下低β-hCG水平输卵管妊娠保守手术局部应用甲氨蝶呤的价值

Discussion of Application Value of Methotrexate Injection in Laparoscopic Conservative Treatment of Low β-hCG Concentration Fallopian Tube Pregnancy

目的探讨腹腔镜下低β-hCG水平的输卵管妊娠保守手术局部注射甲氨蝶呤(methotrexate,MTX)的应用价值。方法选取2015年7月至2017年12月昆明医科大学第一附属医院妇产科输卵管妊娠β-hCG<3 000 IU/L的患者81例,根据术中不同治疗方法分成实验组(腹腔镜下输卵管开窗取胚术+输卵管局部MTX注射)和对照组(腹腔镜下输卵管开窗取胚术)。比较2组术后β-hCG水平下降至正常的时间、术后持续输卵管妊娠的发生率、术后输卵管通畅情况、术后肝肾功能损伤情况。结果实验组术后β-hCG降至正常时间(19.0±10.8) d与对照组(14.8±8.8) d,P>0.05;术后第4天β-hCG水平变化比较,实验组(167.8±113.3) IU/L,对照组(135.6±90.8) IU/L,P>0.05;术后第7天β-hCG水平变化比较,实验组(37.1±35.1I)U/L,对照组(40.3±38.5) IU/L,P>0.05;术后第14天β-hCG水平变化比较,实验组(10.6±9.0I) U/L,对照组(14.7±13.1I) U/L,P>0.05;实验组术后持续输卵管妊娠的发生率(5.26%)与对照组(0%),P>0.05;术侧输卵管通畅情况,实验组(37.0%)与对照组(29.6%),P>0.05;实验组术后肝肾功能损伤1例高于对照组0例。结论β-hCG小于3 000 IU/L的输卵管妊娠腹腔镜保守手术中输卵管局部不使用MTX术并不增加持续性输卵管妊娠和术后输卵管阻塞的风险。

Objective To study the value of MTX injection in laparoscopic conservative treatment of fallopian tube pregnancy. Methods This study included 81 patients with tubal pregnancy and β-hCG<3 000 IU/L between July 2015 and December 2017. According to different intraoperative treatment methods, they were divided into experimental group (laparoscopic fallopian tube fenestration + local MTX injection of fallopian tube) and control group (laparoscopic fallopian tube fenestration). The two groups were compared in terms of the time when the postoperative β-CG level decreased to normal,the incidence of postoperative continuous tubal pregnancy, postoperative tubal patency, and postoperative liver and kidney function injury. Results The time it took for Serum β-hCG concentration being normal in the combination group was(19.0±10.8d)and in the control group was(14.8±8.8d),(P>0.05);Serum β-hCG concentration, measured on day 4, was (167.8±113.3 IU/L) in the combination group, and (135.6±90.8 IU/L)in the control group,(P>0.05);Serum β-hCG concentration , measured on day 7, was (37.1±35.1IU/L) in the combination group, and was(40.3±38.5 IU/L) in the control group,(P>0.05);Serum β-hCG concentration, measured on day 14, was (10.6±9.0 IU/L) in the combination group, and was(14.7±13.1 IU/L)in the control group,(P>0.05);The rate of persistent ectopic pregnancy(PEP) in the combination group was 5.26% and was 0% in the control group(P>0.05);The rate of the operative side fallopian being unobstructed in the combination group was 37.0% and was 29.6% in the control group (P>0.05);One patient was found with abnormal of hepatic and renal function in the combination group,but it wasn't found in the control group. Conclusion Laparoscopic conservative operation with β-hCG less than 3000 IU/L without use of MTX in the fallopian tube does not increase the risk of persistent tubal pregnancy(PEP) and postoperative fallopian tube obstruction.