局部肌注不同剂量甲氨蝶呤联合腹腔镜下输卵管开窗取胚术预防输卵管妊娠术后持续性异位妊娠的效果及对生长因子水平的影响  

Effect of local intramuscular injection of different dose of methotrexate combined with laparoscopic salpingotomy on the prevention of persistent ectopic pregnancy after tubal pregnancy and its influence on growth factors levels

作　　者：刘波艳 赵菲 强焕珍 LIU Boyan;ZHAO Fei;QIANG Huanzhen(the First Hospital of Weinan,Weinan 714000;General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]渭南市第一医院,陕西渭南714000 [2]宁夏医科大学总医院,宁夏银川750004

出　　处：《临床医学研究与实践》2023年第33期140-143,149,共5页Clinical Research and Practice

摘　　要：目的探讨局部肌注不同剂量甲氨蝶呤联合腹腔镜下输卵管开窗取胚术预防输卵管妊娠术后持续性异位妊娠的效果及对生长因子水平的影响。方法选择2018年2月至2020年6月收治的100例输卵管妊娠患者为研究对象,按照随机数字表法将其分为对照组与观察组,各50例。对照组采取局部肌注25 mg甲氨蝶呤联合腹腔镜下输卵管开窗取胚术,观察组采取局部肌注50 mg甲氨蝶呤联合腹腔镜下输卵管开窗取胚术。比较两组的治疗效果。结果观察组的输卵管通畅情况明显优于对照组(P<0.05)。观察组的术后血β-人绒毛膜促性腺激素(β-HCG)恢复正常时间、月经来潮时间、再次妊娠时间短于对照组(P<0.05)。治疗后,观察组的胰岛素生长因子-1(IGF-1)、胰岛素样生长因子结合蛋白-3(IGFBP-3)、血管内皮生长因子(VEGF)水平低于对照组(P<0.05)。观察组的再次同侧异位妊娠率低于对照组,宫内妊娠率高于对照组(P<0.05)。结论局部肌注大剂量甲氨蝶呤联合腹腔镜下输卵管开窗取胚术能够缩短输卵管妊娠术后恢复时间,改善输卵管通畅情况,预防术后持续性异位妊娠,降低生长因子水平,值得推广。Objective To investigate the effect of local intramuscular injection of different dose of methotrexate combined with laparoscopic salpingotomy on the prevention of persistent ectopic pregnancy after tubal pregnancy and its influence on growth factors levels.Methods A total of 100 patients with tubal pregnancy admitted from February 2018 to June 2020 were selected as the research objects and divided into control group and observation group according to the random number table method,with 50 cases in each group.The control group was treated with local intramuscular injection of 25 mg methotrexate combined with laparoscopic salpingotomy,while the observation group was treated with local intramuscular injection of 50 mg methotrexate combined with laparoscopic salpingotomy.The therapeutic effects of the two groups were compared.Results The tubal patency of the observation group was significantly better than that of the control group(P<0.05).The postoperative bloodβ-human chorionic gonadotropin(β-HCG)recovery time,menstrual time and re-pregnancy time in the observation group were shorter than those in the control group(P<0.05).After treatment,the levels of insulin-like growth factor-1(IGF-1),insulin-like growth factor-binding protein-3(IGFBP-3)and vascular endothelial growth factor(VEGF)in the observation group were lower than those in the control group(P<0.05).The rate of recurrent ipsilateral ectopic pregnancy in the observation group was lower than that in the control group,and the rate of intrauterine pregnancy was higher than that in the control group(P<0.05).Conclusion Local intramuscular injection of high-dose methotrexate combined with laparoscopic salpingotomy can shorten the recovery time after tubal pregnancy, improve tubal patency, prevent postoperative persistent ectopic pregnancy, and reduce the levels of growth factors, which is worthy of promotion.

关 键 词：甲氨蝶呤 剂量 腹腔镜下输卵管开窗取胚术 输卵管妊娠 生长因子 

分 类 号：R714[医药卫生—妇产科学]