5-氟尿嘧啶甲氨蝶呤微量泵化疗灌注联合栓塞术治疗输卵管异位妊娠的效果  

Effect of 5-fluorouracil and methotrexate micropump chemotherapy perfusion combined with embolization in the treatment of tubal ectopic pregnancy

作　　者：徐海燕[1,2] 赵明 XU Hai-yan;ZHAO Ming(Zhejiang Chineses Medicine University,Hangzhou,Zhejiang 310053,China;Department of Obstetrics and Gynecology,Zhejiang provincial People's Hospital,Hangzhou,Zhejiang 314408,China;不详)

机构地区：[1]浙江中医药大学,浙江杭州310053 [2]浙江省人民医院妇产科,浙江杭州314408 [3]宁波市第二医院妇产科

出　　处：《中国妇幼保健》2023年第10期1843-1847,共5页Maternal and Child Health Care of China

基　　金：浙江省科技计划技术厅项目(LY18H080328)。

摘　　要：目的分析5-氟尿嘧啶(5-FU)、甲氨蝶呤(MTX)微量泵灌注联合子宫动脉化疗栓塞术(uterine artery chemotherapy and embolization,UACE)在输卵管异位妊娠中的应用。方法采用随机数字表法将2020年10月—2021年12月浙江省人民医院收治的200例输卵管异位妊娠患者分为对照组(100例)和观察组(100例)。所有患者均自愿接受子宫动脉化疗栓塞术治疗,对照组采用MTX灌注,观察组则在对照组基础上加用5-FU灌注;对比两组患者治疗效果、症状及体征改善情况、输卵管畅通及再次妊娠情况,分析治疗前后血清内分泌激素[卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E_(2))、抗苗勒管激素(AMH)]水平,并对比两组患者治疗过程中不良反应发生情况。结果观察组第一疗程治愈患者78例(78.00%),中转手术2例;20例患者接受第二次治疗,治愈患者15例(15.00%),中转手术5例;观察组总共治愈患者93例(93.00%),无效7例(7.00%),UACE无效患者中转手术治疗后均治愈。对照组第一疗程治愈患者57例(57.00%),中转手术12例;31例患者接受第二次治疗,治愈患者25例(25.00%),中转手术6例;对照组总共治愈患者82例(82.00%),无效18例(18.00%),UACE无效患者中转手术治疗后均治愈。观察组治疗总有效率高于对照组(χ^(2)=5.531,P<0.05)。观察组各项症状如腹痛、盆腔包块、阴道出血、β-人绒膜促性腺激素(β-Human Chorionic Gonadotropin,β-hCG)转阴等改善时间均短于对照组(均P<0.05)。观察组输卵管畅通率高于对照组(P<0.05),随访1年后,两组患者宫内妊娠与异位妊娠发生率比较,差异均无统计学意义(均P>0.05)。治疗3个月后,观察组FSH、LH、E_(2)及AMH均低于治疗前和对照组,差异均有统计学意义(均P<0.05)。观察组腹痛、恶心呕吐、发热、肝功能损害、骨髓抑制、口腔溃疡等不良反应总发生率高于对照组,差异均有统计学意义(均P<0.05)。结论对输卵管异位妊娠患者予以5-FU、Objective To analyze the application of 5-fluorouracil(5-FU)and methotrexate(MTX)micropump chemotherapy perfu⁃sion and embolization in ectopic tubal pregnancy(EP).Methods 200 patients with fallopian tube EP admitted from October 2020 to De⁃cember 2021 in our hospital were randomly divided into control group(n=100)and observation group(n=100).All patients voluntarily received uterine artery chemoembolization.The control group received MTX perfusion,and the observation group received 5-FU perfusion on the basis of the control group;Compare the treatment effect,improvement of symptoms and signs,fallopian tube patency and re pregnancy of the two groups of patients,analyze the levels of serum endocrine hormones[follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E_(2)),anti mullerian hormone(AMH)]before and after treatment,and compare the adverse reactions of the two groups of patients during treatment.Results In the observation group,78 patients(78.00%)were cured in the first course of treatment,and 2 pa⁃tients were converted to surgery;20 patients received the second treatment,15 patients were cured(15.00%),5 patients were converted to surgery;In the observation group,93 patients(93.00%)were cured and 7 patients(7.00%)were ineffective.All patients with ineffective UACE were cured after conversion to surgery.In the control group,57 patients(57.00%)were cured in the first course of treatment,and 12 patients were converted to surgery;31 patients received the second treatment,25 patients were cured(25.00%),6 patients were converted to surgery;In the control group,82 patients(82.00%)were cured and 18 patients(18.00%)were ineffective.All patients with ineffective UACE were cured after conversion to surgery.The total effective rate of the observation group was higher than that of the control group(χ^(2)=5.531,P<0.05).In the observation group,symptoms such as abdominal pain,pelvic mass,vaginal bleeding and the improvement time ofβ-hCG turning negative was shorter than that of the control group(P<0.05

关 键 词：5-氟尿嘧啶 甲氨蝶呤 微量泵灌注 子宫动脉化疗栓塞术 输卵管异位妊娠 输卵管畅通 内分泌激素 安全性 

分 类 号：R714.22[医药卫生—妇产科学]