超声引导下妊娠囊内注射天花粉蛋白治疗异位妊娠疗效观察  

Effect of trichosanthin injection into the pregnant cyst on heterotopic pregnancy under the guidance of ultrasonography

作　　者：张华[1] 曾敏华[1] 戴良图[1] 黄玲[1] 朱梅娟[1] 

机构地区：[1]解放军第四一一医院妇产科,上海200081

出　　处：《海军医学杂志》2012年第4期242-244,共3页Journal of Navy Medicine

摘　　要：目的探讨超声引导下妊娠囊内注射天花粉蛋白治疗异位妊娠的临床价值。方法 38例异位妊娠未破裂型患者,根据患者意愿,在知情同意的情况下分为2组:天花粉蛋白介入组24例(天花粉组),其中5例血人绒毛膜促性腺激素(β-HCG)≥15 000 U/L,12例4000～15 000 U/L,7例≤4000 U/L。在超声引导下经阴道后穹窿穿刺附件区包块,注射天花粉蛋白1.2～2.4 mg;14例β-HCG>1000 U/L的异位妊娠未破裂型患者为对照组,患者知情选择手术或口服甲氨蝶呤(MTX)治疗。结果天花粉组24例均治疗成功,大部分患者天花粉介入治疗后3～5 d血β-HCG下降90%以上(治疗成功),3例辅以肌注MTX或天花粉蛋白注射液治疗成功,治疗成功率100%。对照组14例中,12例口服MTX治疗2～3周后,8例血β-HCG下降80%以上(治疗成功);4例口服MTX治疗失败转为手术治疗,另外2例β-HCG>4000 U/L的患者直接行手术治疗。结论超声引导下天花粉介入治疗成功率高,为血β-HCG值较高的未破裂型异位妊娠提供了一种新的治疗方法。Objective To investigate the clinical value of intervention therapy for heterotopic pregnancy under the guidance of ultrasonography. Methods With the desire and knowledge of patients, 24 cases of heterotopic pregnancy of unruptured type were divided into 2 groups. In the trichosanthin intervention group （or simply the trichosanthin group） were 24 cases. Of all the cases, the blood level of β-HCG ≥15 000 IU/L in 5 cases, that of β-HCG was g000 - 15 000 IU/L in 12 cases, and that of β-HCG ≤4000 IU/L in 7 cases. Posterior fornix pucture into the mass was performed under the guidance of uhrasonography, and 1.2 -2.4 mg of trichosanthin were injected. Fourteen cases were used as control. Surgery or oral administration of MTX was chosen as the treatment method, depending on the patients＇ conditions. Results The treatment for the 24 cases in the trichosanthin group was successful. The blood level of β-HCG in most cases decreased by over 90% , following 3 -5 days of intervention therapy. The treatment for the 3 cases coupled with MTX or trichosanthin injection treatment was also successful, with a 100% cure rate. As for the 14 cases in the control group, such were the treatment results： of the 12 cases with oral administration of MTX for 2 -3 weeks, 8 cases had the blood level of β-HCG decreased by over 80% （successful treatment）, 4 cases failed and had to turn to surgical treatment, and another 2 cases with blood level of β-HCG 〉 4000 U/L directly received surgical treatment. Conclusion Trichosanthin intervention therapy with a high rate of success provided a new treatment method for the unruptured heterotopic pregnancy with a higher blood level of β-HCG.

关 键 词：异位妊娠 介入治疗 超声 天花粉蛋白 

分 类 号：R713.8[医药卫生—妇产科学]