输卵管妊娠切开取出缝合术联合甲氨蝶呤对术后宫内妊娠及再发的影响  

Influence of embryo removed by tubal incision and suture combined with methotrexate for treating patients with tubal pregnancy on their incidences of intrauterine pregnancy and repeated tubal pregnancy after treatment

作　　者：孙羽 周福顺 SUN Yu;ZHOU Fushun(Liangxiang Teaching Hospital, Capital Medical University, Beijing, 102488)

机构地区：[1]首都医科大学良乡教学医院,北京102488

出　　处：《中国计划生育学杂志》2021年第11期2317-2320,共4页Chinese Journal of Family Planning

摘　　要：目的:探讨输卵管妊娠切开取出缝合术联合甲氨蝶呤治疗对术后自然妊娠及输卵管妊娠复发影响。方法:选取2013年12月-2018年12月本院收治的输卵管妊娠患者480例,随机数表法分为联合组(240例)和对照组(240例),对照组采用开窗取胚保管术治疗,联合组在对照组基础上联合应用甲氨蝶呤治疗,比较治疗后两组输卵管通畅情况及临床相关指标,随访1年,比较两组宫内妊娠率和输卵管妊娠复发情况。结果:治疗后联合组输卵管完全通畅率(57.9%)和部分通畅率(40.0%)高于对照组(39.6%、52.5%),出院时血绒毛膜促性腺激素水平、住院时间、腹痛消失时间、包块消失时间和月经恢复时间均少于对照组(P<0.05)。1年随访,联合组宫内妊娠率(48.8%)高于对照组(30.4%)(P=0.000),输卵管妊娠复发(3.8%)与对照组(4.6%)无差异(P=0.648)。术后3个月雌二醇、卵泡刺激素和黄体生成素水平两组均较术前降低但组间无差异(P>0.05)。不良反应发生率联合组(5.4%)和对照组(4.6%)无差异(P=0.676)。结论:开窗取胚保管术联合甲氨蝶呤可改善患者输卵管通畅情况,提高患者术后妊娠率,降低重复性输卵管妊娠,未增加不良反应,安全性较好。Objective:To investigate the influence of embryo removed by tubal incision and suture combined with methotrexate for treating patients with tubal pregnancy on their incidences of natural pregnancy and repeated tubal pregnancy after treatment.Methods:From December 2013 to December,480 patients with tubal pregnancy were included and were divided into study group and control group(240 cases in each group)according to random number table.The patients in the control group were given embryo removed by tubal incision and suture in order to tubal preservation,and the patients in the study group were given embryo removed by tubal incision and suture combined with methotrexate in order to tubal preservation.The tubal patency situation and the indicators relevant to clinic of the patients were compared between the two groups.After followed up for 1 year,the intrauterine pregnancy rate and repetitive tubal pregnancy situation of the patients were compared between the two groups.Results:After treatment,the complete tubal patency rate(57.9%)and partial tubal patency rate(40.0%)of the patients in the study group were significant higher than those(39.6%and 52.5%)of the patients in the control group,and the blood chorionic gonadotropin level of the patients in the study group when discharge,the time of hospital stay,the durations of abdominal pain and mass,and the menstrual recovery time of the patients in the study group were significant less than those of the patients in the control group(P<0.05).During the followed up for 1 year,the rate of intrauterine pregnancy(48.8%)of the patients in the study group was significant higher than that(30.4%)of the patients in the control group(P=0.000).There was no significant difference in the recurrence of tubal pregnancy(3.8%vs.4.6%)of the patients between the two groups(P=0.648).The levels of estradiol,follicle stimulating hormone,and luteinizing hormone of the patients in the two groups had decreased significantly in 3 months after operation,but which of the patients had no significant d

关 键 词：输卵管妊娠 开窗取胚保管术 甲氨蝶呤 宫内妊娠 重复性输卵管妊娠 

分 类 号：R71[医药卫生—妇产科学]