腹腔镜术联合甲氨蝶呤注射与非手术方案治疗输卵管妊娠远期效果比较

Effect comparison of laparoscopic conservative surgery combined with local injection of methotrexate and non surgery treatment for treating ectopic tubal pregnancy

目的:对比腹腔镜保守手术联合甲氨蝶呤局部注射与非手术方案治疗输卵管妊娠的效果及远期再受孕情况。方法:选择本院2015年1月—2017年4月接诊的100例输卵管异位妊娠患者,根据患者治疗方式不同分为腹腔镜组和药物组各50例,分别给予腹腔镜保守手术联合甲氨蝶呤局部注射治疗,或甲氨蝶呤及米非司酮药物治疗。比较两组治疗效果。结果:腹腔镜组人绒毛膜促性腺激素(β-hCG)转阴时间、腹痛消失时间、住院时间均短于药物组(10.1±3.1d、14.6±3.6d)(3.9±0.6 d、5.2±0.7 d)(6.0±1.5 d、17.7±2.0d)(P<0.05);不良反应总发生率(6.0%、14.0%)无差异(P>0.05),输卵管通畅率腹腔镜组高于药物组(84.0%、66.0%)(P<0.05)。随访2年后显示,腹腔镜组宫内妊娠高于药物组(66.7%、41.9%),发生再次异位妊娠(6.7%、23.3%)和盆腔炎(6.7%、32.6%)低于对照组(均P<0.05)。结论:和非手术方案相比,腹腔镜保守手术联合甲氨蝶呤局部注射治疗输卵管异位妊娠疗效更佳,具有病情恢复快、输卵管通畅率高、远期宫内妊娠率高等特点。

Objective:To comparison of the effect and long-term pregnancy rate of laparoscopic conservative surgery combined with local injection of methotrexate and non surgery treatment for treating ectopic tubal pregnancy.Methods:100 patients with ectopic tubal pregnancy were selected as research objects from January 2015 to April 2017,and they were divided into observation group and control group according to their condition and voluntary principle(50 cases in each group).The patients in the observation group were treated with laparoscopic conservative surgery combined with local injection of methotrexate,while the patients in the control group were treated with methotrexate combined with mifepristone.The therapeutic effect of patients was compared between the two groups.Results:The time of human chorionic gonadotropin(β-hCG)level turned to negative,the disappearance time of abdominal pain,and the hospitalization time of patients in the observation group were 10.1±3.1d,3.9±0.6 d,and 6.0±1.5 d,respectively,which were significant shorter than those(14.6±3.6d,5.2±0.7 d,and 17.7±2.0d,respectively)of patients in the control group(P<0.05).The total incidence of adverse reactions of patients in the observation group was 6.0%,which had no significant different from that(14.0%)of patients in the control group(P>0.05).The fallopian tube patency rate of patients in the observation group was 84.0%,which was significant higher than that(66.0%)of patients in the control group(P<0.05).2 years followed up,the intrauterine pregnancy rate of patients in the observation group was 66.7%,which was significant higher than that(41.9%)of patients in the control group,and the rates of re-ectopic pregnancy and pelvic inflammation of patients in the observation group were 6.7%and 6.7%,which were significant lower than those(23.3%and 32.6%)of patients in the control group(all P<0.05).Conclusion:Compared with that no surgery treatment,the laparoscopic conservative surgery combined with local injection of methotrexate for treating ectopic tubal pregnancy is more effective and safety,which has the characteristics of rapid recovery,high patency rate of fallopian tube,and long-term intrauterine pregnancy rate.