腹腔镜下患侧输卵管切开取胚术配伍氨甲蝶呤局部注射的疗效分析  

Analysis on the therapeutic effects of laparoscopic affected salpingotomy combined with local injection of methotrexate

作　　者：袁海英[1] 王建霞[1] 高娟[1] 姜静霞[1] 

机构地区：[1]江苏省江阴市中医院妇产科,江苏江阴214400

出　　处：《实用临床医药杂志》2013年第14期28-31,共4页Journal of Clinical Medicine in Practice

基　　金：中国高校医学期刊临床专项资金(11321037)

摘　　要：目的探讨腹腔镜下患侧输卵管切开取胚术配伍氨甲蝶呤局部注射的临床疗效。方法将100例输卵管妊娠患者随机分为治疗组和对照组,治疗组接受患侧输卵管切开取胚术配伍氨甲蝶呤(MTX)局部注射治疗,对照组接受患侧输卵管切除术治疗。比较2组患者的手术时间、术中出血量,手术前后血β绒毛膜促性腺激素(βHCG)及血黄体酮的变化,3个月后观察患者输卵管功能恢复情况及重复性、持续性异位妊娠的发生情况。结果当患者血βHCG≤3 000 IU/L且附件包块≤40mm时,2组手术时间、术中出血量无差异;而当血βHCG>3 000 IU/L且附件包块>40 mm时,治疗组手术时间及术中出血量显著多于对照组;术后2组血βHCG及血黄体酮均比术前明显下降,但2组比较差异无统计学意义。治疗组输卵管功能恢复情况显著优于对照组,且重复性异位妊娠发生率显著低于对照组。结论在良好控制适应证的情况下,腹腔镜下患侧输卵管切开取胚术配伍MTX局部注射能有效治疗输卵管妊娠,预防重复性和持续性异位妊娠的发生,且安全可行。Objective To observe the clinical effects of laparoscopic affected salpingotomy combined with local injection of methotrexate.Methods One hundred patients with tubal pregnancy were grouped into treatment group and control group randomly.The patients in treatment group received laparoscopic affected salpingotomy combined with local injection of methotrexate （MTX）,while those in control group received the affected salpingectomy.The operation time,intraoperative bleeding,blood β chorionic gonadotropin （β-HCG） and progesterone before and after operation were compared in both groups.Three months later,the conditions of tubal function recovery,repeated and persistent ectopic pregnancy occurrence were observed.Results When blood β-HCG ≤3 000 IU/L and adnexal lump ≤40 mm,there was no difference between the operation time and intraoperative bleeding,but when β-HCG ＞3 000 IU/L and adnexal lump ＞40 mm,the operation time and intraoperative bleeding in the treatment group were more than that in the control group obviously.Postoperative blood β-HCG and progesterone decreased remarkably in comparison to operation before,but the difference showed no statistical significance.The condition of tubal function recovery in the treatment group was obviously better than that in the control group,and the incidence of repeated ectopic pregnancy notably lower than the control group.Conclusion Under the condition of controlling the indications better,laparoscopic affected salpingotomy combined with local injection of methotrexate can treat tubal pregnancy effectively,and prevent the occurrence of repeated and persistent ectopic pregnancy.

关 键 词：输卵管妊娠 腹腔镜 输卵管切开取胚术 氨甲蝶呤 输卵管切除术 

分 类 号：R713.5[医药卫生—妇产科学]