宫腔镜下输卵管插管注射甲氨蝶呤治疗稳定型输卵管妊娠

Methotrexate injection by hysteroscopic tubal catheterization in the treatment of unruptured tubal pregnancy

目的 评价在电视宫腔镜引导下输卵管插管局部注入甲氨蝶呤 (MTX)治疗稳定型输卵管妊娠的近期效果 ,探讨影响该方法疗效的因素。 方法 对 2 0 0 0年 10月～ 2 0 0 2年 9月稳定型输卵管妊娠 82例 ,在宫腔镜引导下输卵管插管注射MTX 2 0mg(10ml) ,观察临床效果及副作用。对用药后 72h血清β -HCG下降 <5 0 %者重复用药一次。 结果 临床总治愈率82 9% (6 8 82 ) ,单次给药者临床治愈率 72 0 % (5 9 82 )。治愈时间 (10± 4 9)天。逐步回归分析显示 :注药时药物返流、给药后 72h血清 β-HCG下降水平及术前血清β -HCG≥ 4 0 0 0mIu ml均明显影响疗效 (P值分别为 0 0 0 0、0 0 0 1、0 .0 32 )。无明显副作用发生。 2月后 6 5例插管治疗治愈患者随访 ,其中 5 7例 (87 7% )月经恢复正常。 结论 电视宫腔镜引导下输卵管插管局部注射MTX治疗稳定型输卵管妊娠疗效较好 ,方法简单 ,患者创伤小 ,无明显副作用。

Objective To evaluate the short-term effects of methotrexate (MTX) injection by hysteroscopic tubal catheterization for unruptured tubal pregnancy, and to investigate factors influencing curative effects of such approach. Methods A total of 82 patients with unruptured tubal pregnancy underwent injection of MTX 20 mg (10ml) by hysteroscopic tubal catheterization from October 2000 to September 2002. Clinical efficiency and side effects were recorded. After administration for 72 hours, in case serum β-HCG level had dropped less than 50 percent, a second injection of MTX was given. Results The total cure rate was 82.9% (68/82), and 72.0% (59/82) of the patients were cured clinically with the first administration of MTX, with the length of hospitalization being (10±4.9) days. Statistically, the drug reflux at injection, the declining level of β-HCG after administration, and the serum level of β-HCG ≥ 4000 mIu/ml before administration significantly influenced the curative effects (P=0.000, P=0.001, P=0.032, respectively). No side effects were found in this study. Out of the 65 cured patients followed up for 2 months,57 (87.7%) got normal menstruation. Conclusions MTX injection by hysteroscopic tubal catheterization for unruptured tubal pregnancy is effective, simple, minimally invasive and safe.