甲氨蝶呤治疗异位妊娠56例失败分析

ANALYSIS OF THE FAILURE OF 56 ECTOPIC PREGNANCIES TREATED BY METHOTREXATE

目的 :探索甲氨蝶呤 ( MTX)治疗异位妊娠的最佳适用范围。方法 :将异位妊娠患者 1 83例随机分两组 :A组 MTX2 0 mg肌注连用 5 d,B组 MTX5 0 mg/m2单次肌注。结果 :两组治疗失败率无显著性差异( P>0 .0 5 )。异位妊娠包块 <3cm者成功率为 81 .8%;包块 3～ 5 cm者成功率为 65 .3%;包块 >5 cm者成功率为 5 7.1 %。三组比较有显著性差异 ( P<0 .0 5 ) ;血 β- HCG<1 0 0 0 U/L者成功率为 80 .6%;1 0 0 0～5 0 0 0 U/L者成功率为 76.5 %;>5 0 0 0 U/L者成功率为 37.5 %,三组比较有极显著性差异 ( P<0 .0 1 )。结论 :MTX单次肌肉注射效果最佳 ,异位妊娠包块 <3cm、血 β- HCG<1 0 0 0 U/L者可以作为 MTX保守治疗的指征。

Objective:To explore the indication of intramuscular methotrexate(MTX) to treat ectopic pregnancy.Methods::One hundred and eighty three cases of ectopic pregnancy were divided into two groups:group A was treated by intramuscular MTX 20 mg/d for 5 d and group B was treated by single dose intramuscular MTX 50 mg.Results:The failure rates of two groups showed no significant difference ( P >0 05).The successful cases with ectopic mass <3 cm,3-5 cm,>5 cm were 81 8%,63 3%,and 57 1% respectively with significant difference among these three groups.The success rates was 80 6%,76 5%,and 37 5% when serum β HCB was <1 000 U/L,1 000-5 000 U/L,and >5 000 U/L,respectively,with no significant difference.Conclusion:The efficacy of single dose intramuscular MTX was better.Ectopic mass <3 cm in greatest dimension and titer of serum β HCG<5 000 U/L were indications of drug treatment.