输卵管异位妊娠腹腔镜手术后甲氨蝶呤的选择性使用

Tubal ectopic pregnancy after laparoscopic surgery choice application of methotrexate

目的:比较未破裂输卵管异位妊娠采用腹腔镜保守手术后非常规使用甲氨蝶呤(MTX)和常规使用甲氨蝶呤两种方法的疗效及甲氨蝶呤的副作用发生率。方法:收集我院2012年4月至2016年12月间116例未破裂型输卵管异位妊娠并有生育愿望的患者进行前瞻性研究,将其分为腹腔镜保守手术后常规联合甲氨蝶呤(对照组)和术后以β-HCG在24~48小时内下降程度为判定指标来选择性使用甲氨蝶呤组(实验组)和进行治疗,对照组58例,实验组58例。比较两组患者在治愈率、血清β-HCG下降至正常的时间、月经复潮时间、甲氨蝶呤不良反应发生率和住院时间有无统计学差异。结果:在治愈率、血清β-HCG降至正常的时间及月经复潮时间上实验组与对照组差异无统计学意义。在住院时间和不良反应发生率上实验组均低于对照组,差异有统计学意义。结论:对有保留生育功能需求的未破裂型输卵管妊娠患者在予以腹腔镜保守手术治疗后不常规使用甲氨蝶呤,而是依据术后24~48小时β-HCG下降水平选择使用甲氨蝶呤(MTX)治疗,此方案不仅能取得同样的疗效,同时大大减少了甲氨蝶呤的使用率,从而避免了使用甲氨蝶呤可能带来的相关副作用,缩短了住院时间,值得在临床上推广。

Objective To compare the curative effect and incidence of side effects of methotrexate of after laparoscopic conservative surgery unconventional use of methotrexate(MTX) treatment of unruptured tubal ectopic pregnancy and laparoscopic conservative surgery conventional combined methotrexate treatment of unruptured tubal ectopic pregnancy. Methods Collected 116 ectopic pregnancy patients without ruptured fallopian tube have fertility requirements from April 2012 to December 2016 for prospective study and were divided into laparoscopic conservative surgery choice application methotrexate group(experimental group) and laparoscopic conservative surgery routine combined methotrexate treatment(control group), 58 cases in which the experimental group and control group in 58 cases. The comparison of two groups of patients with the cure rate, serum beta HCG dropped to normal time, the time of menstruation is again, the tideincidence of adverse reactions, and length of hospital stay. Results The experimental group in cure rate, blood beta HCG dropped to normal time and the time of menstruation is again compare to the control group, there was no statistically significant difference. On the length of hospital stay and the incidence of adverse reactions to the experimental group were lower than the control group, the difference was statistically significant. Conclusion Unruptured tubal ectopic pregnancy can be treated by laparoscopic conservative surgery alone, first 24 to 48 hours after application on the basis of beta HCG drops level selection methotrexate(MTX) treatment, the scheme can not only get the same results, at the same time reduce the efficiency of the methotrexate, avoiding using methotrexate can bring the related side effects, also shortened the length of hospital stay, is worth popularizing in clinic.