经阴道B超引导下胚胎减灭术联合MTX治疗在特殊类型异位妊娠中的应用

Application of transvaginal B-ultrasound guided embryo reduction combined with MTX in the treatment of special ectopic pregnancy

目的探讨经阴道B超引导下胚胎减灭术联合氨甲蝶呤(MTX)在特殊类型异位妊娠中的临床应用价值。方法收集38例特殊类型异位妊娠患者,15例患者接受经阴道超声引导下减灭异位妊娠胚胎联合孕囊局部注射MTX治疗(A组),23例患者接受保守手术治疗(B组)。回顾性分析2组患者的临床资料,并比较2种方法的治疗结局。结果A组13例治疗成功,成功率为86.67%;1例输卵管妊娠术后2 d输卵管妊娠破裂急诊手术行输卵管切除术,1例输卵管妊娠术后3 d因腹痛进行急诊手术,术中提示输卵管妊娠流产。2组患者术前HCG水平,术后1周HCG水平及治疗后HCG下降水平比较差异无统计学意义(P>0.05)。A组治疗费用明显低于B组(P<0.05)。结论经阴道超声引导下胚胎减灭术联合孕囊局部注射MTX是一种治疗特殊类型异位妊娠的行之有效的方法。

Objective To investigate the clinical application value of transvaginal ultrasound guided embryo reduction combined with methotrexate(MTX)in special types of ectopic pregnancy.Methods 38 patients with special types of ectopic pregnancy were collected,15 patients received transvaginal ultrasound guided reduction of ectopic pregnancy embryos combined with local injection of MTX into the gestational sac(Group A),and 23 patients received conservative surgical treatment(Group B).The clinical data of the two groups of patients were retrospectively analyzed,and the treatment outcomes of the two methods were compared.Results In Group A,13 cases were treated successfully,success rate of 86.67%.One case of tubal pregnancy underwent emergency surgery for tubal pregnancy rupture two days after surgery.Another case underwent emergency surgery for tubal pregnancy three days after surgery due to abdominal pain,and the patient was prompted to have a miscarriage of tubal pregnancy during the operation.There was no statistical significance in comparison of preoperative HCG levels,postoperative HCG levels,and HCG decline levels after treatment between the two groups(P>0.05).The cost of treatment in Group A was significantly lower than that in Group B(P<0.05).Conclusion Transvaginal ultrasound guided embryo reduction surgery combined with local injection of MTX into the gestational sac is an effective method for treating special types of ectopic pregnancy.