腹腔镜手术联合药物治疗异位妊娠的临床研究  

A clinical study on laparoscopic surgical treatment combined with drug treatment for tubal pregnancy

作　　者：王德朋[1] 姜华[1] 田秦杰[2] 

机构地区：[1]山东省淄博市妇幼保健院,山东淄博255029 [2]北京协和医院,北京100730

出　　处：《中国妇幼健康研究》2009年第6期675-676,共2页Chinese Journal of Woman and Child Health Research

摘　　要：目的探讨杀胚药物在输卵管妊娠腹腔镜保守性手术中预防性应用的临床价值。方法收集131例有生育要求且输卵管未破裂输卵管妊娠患者的病史资料。根据围手术期是否应用杀胚药物分为用药组（n=85）和对照组（13=46）。分别对两组患者的一般资料数据、术后血人绒毛膜促性腺激素下降情况、术后持续性异位妊娠发生率、术后3个月随访子宫输卵管碘油造影术的结果、用药组的药物不良反应情况进行比较分析。结果用药组术后血人绒毛膜促性腺激素值下降迅速，其降至正常所需时间短，与对照组比较有显著性差异（t=2．35，P〈0．05）；用药组术后1例发生持续性异位妊娠，对照组6例发生持续性异位妊娠，两组患者持续性异位妊娠发生率比较有显著性差异（1．2％vs13．0％；χ^2=8．31，P〈0．05）；术后3个月共有112例患者接受随访，并行子宫输卵管碘油造影检查，用药组（n=74）与对照组（n=38）患者的术后输卵管通畅率比较无显著性差异（66．2％VS68．4％χ^2=0．06，P〉0．05）；用药组患者未见有明显的呕吐及口腔溃疡等不良反应，血象无明显变化。结论杀胚药物在输卵管妊娠腹腔镜保守性手术中围手术期应用可明显降低持续性异住妊娠的发生率；药物使用不影响手术效果，且无明显不良反应。Objective To evaluate clinical value of preventive use of embryo-killing drugs in laparoscopic conservative surgical treatment of tubal pregnancy. Methods The clinical data of 131 patients with unruptured tubal pregnancy who desired to bear a child were collected. The patients were divided into medication group（ n = 85 ） and control group （n = 46） according to whether the patient was given embryo- killing drugs in perioperative period. The patients＇ s general information, postoperative decline of serum level ofβ -hCG, incidence rate of persistent ectopic pregnancy （PEP） after operation, results of hysteresalpingography （HSG） in follow up at 3 months after operation and adverse effects of drugs in the medication group were compared and analyzed between the two groups. Results The postoperative serum level of β-hCG of the patients in the medication group declined sharply and time of serum level of β-hCG dropping to normal range was shorter as compared with that in the control group, and the difference was statistically significant （ t = 2.35, P 〈 0.05 ）. 1 case of PEP occurred in the medication group and 6 cases of PEP occurred in the control group and there was a significant difference in incidence of PEP between the two groups （ 1.2% vs 13.0%, χ^2 = 8.31, P 〈 0.05 ）. At 3 months after operation, 112 patients were followed up and were examined with hysterosalpingography （HSG） and in bilateral tubal patency rate there was no significant difference between the two groups （ 74 patients in the medication group and 38 patients in the control group, 66.2% vs 68.4%, χ^2 = 0.06, P 〉 0.05）. There were no severe side effects such as nausea, vomitting and oral ulceration and no significant changes in hemograms were found in the medication group. Conclusion Use of embryo-killing drugs in perioperative period of laparoscopic conservative surgical treatment of tubal pregnancy can significantly lower incidence of PEP. Furthermore, the medication does not influence therapeutic effect o

关 键 词：甲氨蝶呤 米非司酮 输卵管妊娠 保守治疗 持续性异位妊娠 

分 类 号：R714.22[医药卫生—妇产科学]