单剂量甲氨蝶呤治疗输卵管妊娠117例报道

Single-dose methotrexate treatment for ectopic pregnancy:a report of 117 cases

目的探讨单剂量甲氨蝶呤(MTX)治疗输卵管妊娠的疗效和相关因素。方法回顾性分析接受MTX 50 mg/m^2单剂量肌内注射治疗的117例输卵管妊娠患者的临床资料,分析一般特征、临床症状、血人绒毛膜促性腺激素(HCG)、超声表现和治疗结果的关系。结果117例输卵管妊娠患者的中位血HCG为768.7 IU/L,成功率为82.9%。停经和阴道出血时间长成功率高(P<0.05)。治疗前低血HCG成功率高于高血HCG(P<0.01)。治疗后1~4d和1~7 d血HCG下降>15%成功率更高(P<0.05或P<0.01),治疗后4~7 d血HCG下降无统计学意义(P>0.05)。结论MTX是治疗血流动力学稳定输卵管妊娠的可选择治疗方式,血HCG是治疗效果的主要相关因素,输卵管妊娠自然史多样,需要探讨细化参数和更好费效关系的治疗建议。

Objective To evaluate the effect and it's related factors of single-dose methotrexate(MTX)regimen for tubal pregnancy.Methods A retrospective observation study of 117 patients with tubal pregnancy who were treated with a single-dose protocol of 50 mg/m^2 of MTX injected intramuscularly was performed.The relationship l)etween general features,clinical symptoms,serum human chorionic gonadotropin(HCG),ultrasound parameters and treatment outcome was analyzed.Results The median serum HCG value of 117 patients with tubal pregnancy was 768.7 IU/L,and the success rate was 82.9%.The success rate was higher in paitents with prolonged menopause and vaginal bleeding(P<0.05).The success rate was higher in patients with low level of pretreatment serum HCG than in patients with high level of pretreatment serum HCG(P<0.01).The higher success rate was observed in patients with more than 15%decline of serum HCG from day 1 to day 4 and day 1 to day 7 after MTX therapy(P<0.05 or P<0.01).The decline of serum HCG from day 4 to day 7 had no significant effect on the success rate(P>0.05).Conclusions MTX therapy is an alternative treatment for hemodynamically stable tubal pregnancy.Blood HCG level is the main factor related to the treatment effect.The natural history of tubal pregnancy is diverse.It is necessary to explore the detailed parameters and better cost一effective treatment recommendations.