小剂量甲氨蝶呤联合腹腔镜保守手术治疗异位妊娠的效果观察

Effect of low-dose methotrexate combined with laparoscopic conservative surgery on patients with ectopic pregnancy

目的探讨小剂量甲氨蝶呤联合腹腔镜保守手术治疗异位妊娠的效果。方法抽取2018年2月至2020年2月周口市中心医院异位妊娠患者80例,按随机数字表法分为药物组(40例)与腹腔镜组(40例)。腹腔镜组单纯采用腹腔镜手术保守治疗,药物组在腹腔镜组基础上加用小剂量甲氨蝶呤治疗,对比两组人绒毛膜促性腺激素(β-HCG)水平、预后效果、围术期情况(术中出血量、手术时间、住院时间)、恢复情况。结果术后1、7、14 d,药物组β-HCG水平较腹腔镜组低(P<0.05);药物组术中出血量较腹腔镜组少,手术时间、住院时间较腹腔镜组短(P<0.05);药物组术后排气时间、β-HCG水平降至正常时间较腹腔镜组短(P<0.05);药物组正常妊娠率、输卵管复通率较腹腔镜组高,持续性异位妊娠(PEP)发生率较腹腔镜组低(P<0.05)。结论小剂量甲氨蝶呤联合腹腔镜手术保守应用于异位妊娠患者中,可降低β-HCG水平,改善围术期情况,帮助术后恢复,提高正常妊娠、输卵管复通率,降低PEP发生率,利于改善预后。

Objective To explore the effect of low-dose methotrexate combined with laparoscopic conservative surgery on patients with ectopic pregnancy.Methods A total of 80 patients with ectopic pregnancy in Zhoukou Central Hospital from February 2018 to February 2020 were selected,and divided into drug group(n=40)and laparoscopic group(n=40)according to the random number table method.The laparoscopic group was treated with laparoscopic conservative surgery,and the drug group was treated with low-dose methotrexate on the basis of the laparoscopic group.The levels of beta human chorionic gonadotropin(β-HCG),prognostic effects,perioperative conditions(intraoperative blood loss,operation time,length of hospital stay)and recovery were compared between the two groups.Results The levels of β-HCG in the drug group were lower than those in the laparoscopy group at 1 day,7 days and 14 days after operation(P<0.05).The amount of intraoperative blood loss in the drug group was less than that in the laparoscopic group,and the operation time and hospital stay were shorter than those in the laparoscopic group(P<0.05).The postoperative exhaust time and β-HCG level down to normal time in the drug group were shorter than those in the laparoscopic group(P<0.05).The normal pregnancy rate and tubal recanalization rate in the drug group were higher than those in the laparoscopic group,and the incidence of persistent ectopic pregnancy(PEP)was lower than that in the laparoscopic group(P<0.05).Conclusions Low-dose methotrexate combined with laparoscopic conservative surgery in patients with ectopic pregnancy can reduce the level of β-HCG,improve perioperative conditions,help postoperative recovery,improve the rate of normal pregnancy and fallopian tube recanalization rate,reduce the incidence of PEP,and improve the prognosis.