甲氨蝶呤两种应用方案联合米非司酮治疗异位妊娠的临床研究

目的:探讨甲氨蝶呤两种应用方法联合米非司酮治疗异位妊娠的临床疗效和不良反应,指导临床用药.方法:对128例确诊异位妊娠的患者,随机分为A、B两组.A组64例:甲氨蝶呤0.4 mg/(kg·d),肌内注射5天,联合米非司酮25 mg,每天2次口服,用3天;B组64例:甲氨蝶呤1 mg/kg,单次肌内注射,联合米非司酮25 mg,每天2次口服,用3天,观察两组的临床疗效和不良反应.结果:当血β-HCG定量<2000 U/L时,使用A组方案治疗异位妊娠的治愈率为98.43%,B组为95.31%,差异无统计学意义(P>0.05);A组Ⅱ度、Ⅲ度胃肠道反应及血细胞计数下降发生率明显高于B组,差异有统计学意义(P<0.05).结论:对于较低血β-HCG水平的异位妊娠患者使用甲氨蝶呤1mg/kg单次肌内注射联合米非司酮治疗,疗效好且更为安全.     

不同体重指数异位妊娠患者采用甲氨蝶呤保守治疗的临床疗效分析

目的:研究甲氨蝶呤(MTX)对不同体重指数(BMI)异位妊娠患者的保守治疗效果。方法:随机将120例患者分为两组:MTX 50mg/m~2单次肌注组(单次组,60例),MTX 0.4mg/(kg·d)肌注连续5天治疗组(多次组,60例)。比较体重指数(BMI)25kg/m~2及BMI≥25kg/m~2的患者采用两种治疗方案的有效率及不良反应发生率。结果:单次组患者的治疗有效率(75.00%)低于多次组(85.00%),但差异无统计学意义(P0.05),治疗后不良反应发生率(10.00%)低于多次组(33.00%),差异有统计学意义(P0.05)。BMI25kg/m~2组患者中,单次和多次组的治疗有效率和不良反应发生率比较,差异均无统计学意义(P0.05)。BMI≥25kg/m~2组中,单次组的治疗有效率和不良反应发生率低于多次组,差异均有统计学意义(P0.05)。结论:患者体型正常时,两种给药方案的疗效相当,但50mg/m~2单次肌注,给药简单方便,依从性好,可首选。患者为肥胖体型时,选择0.4mg/(kg·d)肌注连续5日给药方案,疗效更好,但不良反应增加。     

甲氨蝶呤联合米非司酮治疗异位妊娠的临床观察

目的:探讨甲氨蝶呤联合米非司酮治疗异位妊娠的治疗效果及安全性,为药物保守治疗异位妊娠寻找新的方法.方法:将2010年1月至2011年12月在我院确诊为异位妊娠并符合保守治疗条件的70例患者随机分为两个治疗组,以单用甲氨蝶呤治疗34例为对照组,甲氨蝶呤联合米非司酮治疗36例为研究组,观察比较两组的治疗效果.结果:两组均于治疗后2周血β-HCG明显下降,包块平均直径明显缩小,与治疗前比较差异有统计学意义(P ＜0.05,P＜0.01).研究组及对照组治愈率分别为91.67％和76.47％,两组比较差异有统计学意义(P＜0.05).研究组胃肠道反应发生率低于对照组,差异有统计学意义(P＜0.05).结论:甲氨蝶呤联合米非司酮治疗异位妊娠的效果优于单用甲氨蝶呤,且有疗效高、副反应较小的优点.     

甲氨蝶呤治疗异位妊娠失败19例分析

目的 :探讨甲氨蝶呤 (MTX)单次肌内注射治疗异位妊娠失败的原因。方法 :MTX单次 5 0 mg/ m2肌内注射 ,最多注射 2次。结果 :治疗 5 1例 ,成功 32例 ,成功率 6 2 .74% ,失败 19例 ,失败率 37.2 5 %。结论 :患者症状轻 ,没有明显内出血情况 ,能动态观察血 HCG变化 ,血 HCG<15 6 2 5 IU/ L,B超盆腔包块 <5 0 m m,后穹窿积液 <30 mm× 30 mm,MTX单次肌内注射成功可能性极大     

异位妊娠保守治疗的临床观察

目的：观察甲氨蝶呤（MTX）联合米非司酮治疗异位妊娠的疗效。方法：回顾性分析符合保守治疗条件,采用单纯MTX（29例）和MTX联合米非司酮（31例）治疗的异位妊娠患者的资料,比较2组的成功率、住院时间以及治疗后β人绒毛膜促性腺激素（β-hCG）恢复正常时间。结果：治疗组成功率、住院时间以及治疗后B—hCG恢复正常时间分别为90．3％、（13．9±1．3）d和（12．8±1．2）d,对照组分别为65．5％、（20．9±6．2）d和（23．6±2．9）d,2组差别有统计学意义（P〈0．01）。结论：MTX联合米非司酮治疗异位妊娠效果好,恢复快,优于其单独使用。     

米非司酮联合甲氨蝶呤治疗异位妊娠疗效分析

目的：探讨米非司酮联合甲氨蝶呤治疗异位妊娠的疗效。方法：选择2010年2月至2013年2月在湖北省当阳市妇幼保健院治疗的116例异位妊娠患者,随机分为观察组和对照组,其中观察组60例,采用米非司酮联合甲氨蝶呤治疗;对照组56例,采用甲氨蝶呤治疗,比较两组疗效。结果：观察组54例治疗成功,成功率91.6%,对照组40例治疗成功,成功率71.4%,P0.05。结论：米非司酮联合甲氨蝶呤治疗异位妊娠疗效好,缩短？HCG下降时间、包块消失及阴道出血时间。     

异位妊娠保守治疗的临床观察

目的：观察甲氨蝶呤（MTX）联合米非司酮治疗异位妊娠的疗效。方法：回顾性分析符合保守治疗条件,采用单纯MTX（29例）和MTX联合米非司酮（31例）治疗的异位妊娠患者的资料,比较2组的成功率、住院时间以及治疗后β人绒毛膜促性腺激素（β-hCG）恢复正常时间。结果：治疗组成功率、住院时间以及治疗后β-hCG恢复正常时间分别为90.3%、（13.9±1.3）d和（12.8±1.2）d,对照组分别为65.5%、（20.9±6.2）d 和（23.6±2.9）d,2组差别有统计学意义（P ＜0.01）。结论：MTX联合米非司酮治疗异位妊娠效果好,恢复快,优于其单独使用。     

甲氨蝶呤联合米非司酮治疗异位妊娠52例分析

目的 探讨甲氨蝶呤(MTX)联合米非司酮治疗异位妊娠的疗效。方法 选取符合保守治疗条件的异位妊娠52例，给予甲氨蝶呤20mg肌肉注射，每日1次，共5天；米非司酮50Ⅱlg，每日2次口服，共2日。结果 52例成功48例，成功率92．3％；失败4例，失败率7．7％。结论 MTX联合米非司酮治疗异位妊娠有较好的临床效果。     

甲氨蝶呤联合米非司酮保守治疗异位妊娠52例分析

目的 探讨甲氨蝶呤联合米非司酮治疗输卵管妊娠的效果。方法 将收治的52例确诊为异位妊娠要求保守治疗的病例随机分为两组，观察组30例，采用甲氨蝶呤联合米非司酮治疗；对照组22例，单用甲氨蝶呤治疗。结果 观察组治愈26例，治愈率86．7％；对照组治愈12例，治愈率为54．5％，两组治愈率比较，差异有显著性（P〈0.05）。结论 两种方法间比较，甲氨蝶呤联合米非司酮治疗方法较优，值得推广。     

米非司酮联合甲氨蝶呤治疗异位妊娠

目的 探讨米非司酮联合甲氨蝶呤治疗异位妊娠的效果。方法 78例输卵管妊娠患者随机分为A、B两组，A组42例给予米非司酮，3次／d，口服，每次50mg，连续3天，同时给予甲氨蝶呤60mg一次性肌肉注射。B组36例，给予甲氨蝶呤60mg一次性肌肉注射。定期检测血β—HCG、血常规、肝、肾、凝血功能、B超。结果 米非司酮联合甲氨蝶呤治疗异位妊娠成功率为88．09％，明显高于对照组。治疗效果与用药方案及治疗前血β—HCG水平有关。结论 米非司酮联合甲氨蝶呤治疗异位妊娠安全有效，早期诊断、严格掌握适应证是治疗成功的关键。     

甲氨蝶呤预防腹腔镜手术后持续性异位妊娠的研究

目的:探讨异位妊娠腹腔镜保守性手术后预防持续性异位妊娠(PEP)的方法。方法:对86例输卵管妊娠患者行腹腔镜保守性手术后随机分成两组:A组采用甲氨蝶呤(MTX)注入患侧输卵管近端残腔;B组除用MTX外,并于术后口服米非司酮。所有患者均于术前及术后24小时、72小时、7天、12天检测血-βHCG值并观察其毒副反应的发生。结果:A组PEP发生1例(2.27%),B组2例(4.76%),差异无显著性(P>0.05);术后24小时血-βHCG值较术前明显下降(P<0.01),但两组间差异无显著性(P>0.05);术后72小时、7天血-βHCG值两组间差异无显著性(P>0.05),但12天两组间差异有非常显著性,B组明显高于A组(P<0.01);且B组出现的毒副反应明显多于A组。结论:单用MTX对异位妊娠腹腔镜保守性手术后预防PEP发生,可能要优于MTX加米非司酮。     

Laparoscopic Resection of Cesarean Scar Ectopic Pregnancy after Unsuccessful Systemic Methotrexate Treatment

Study Objective

To present a case of a cesarean scar ectopic pregnancy treated by laparoscopic resection followed by isthmocele repair.

Retrospective Study on Laparoscopic Management of Ectopic Pregnancy

Purpose

To evaluate various laparoscopic methods for management of tubal ectopic pregnancy and study the incidence of ectopic pregnancy including the incidence of cornual ectopic pregnancy and conversion to laparotomy during laparoscopic procedure.

Methods

A retrospective study was conducted in North Point Hospital, Delhi, on all laparoscopies conducted in 4 years, i.e., from January 2008 to December 2011.

Results

Incidence of ectopic pregnancy was 4.62 % (out of all laparoscopic surgeries over 4 years) and that for cornual pregnancy was 4.65 % (out of all ectopic pregnancies); no laparotomy was done for the management of ectopic pregnancy. The site of ectopic pregnancy in the tubal pregnancy varied, with 76.75 % in the ampullary region, 16.27 % isthumic, 2.33 % fimbrial, and 4.65 % in the cornual region. Salpingectomy was done in 53.5 % cases and 46.5 % of patients underwent a conservative approach in the form of salpingostomy.

Conclusion

The laparoscopic management of ectopic pregnancy is a safe and effective option with greatly reduced morbidity.     

天花粉、甲氨蝶呤、米非司酮对异位妊娠保守治疗的研究

目的:探索异位妊娠保守治疗的最佳疗效方案。方法:对昆明市延安医院1253例异位妊娠,其中676例行保守治疗。按用药分为用天花粉(A组310例)、甲氨蝶呤(MTX,B组70例)、米非司酮(C组60例)、MTX加米非司酮(D组184例)、天花粉加MTX加米非司酮(E组52例),观察疗效。结果:异位妊娠的保守治疗中E组成功率为94.0%,D组成功率为85.87%,A组成功率为85.16%,B组成功率为81.42%,C组成功率为60.00%。结论:临床显示,异位妊娠疗效方案E组疗效最佳,D组和A组有较高的临床应用优势。其次是B组,疗效最差的是C组。     

Nonsurgical Management of Live Tubal Ectopic Pregnancy by Ultrasound-Guided Local Injection and Systemic Methotrexate

Study ObjectiveTo evaluate outcomes relative to treatment using systemic methotrexate (MTX) alone or systemic MTX combined with ultrasound (US)–guided local injection of potassium chloride (KCl) or MTX in women with live tubal ectopic pregnancies.DesignCase-control study (Canadian Task Force classification II-2).SettingDepartments of Obstetrics and Gynecology in 2 hospitals in China.PatientsEighty-two women with live tubal ectopic pregnancies.InterventionParticipants in the study received treatment using either systemic MTX (n = 37; systemic treatment group) or systemic MTX and US-guided local injection of either MTX or KCl (n = 45; combined treatment group).Measurements and Main ResultsPatient clinical features and outcomes were compared. There were no significant differences between the patient groups insofar as baseline gestational age, β-human chorionic gonadotropin concentration, or size of conceptus. The success rate in patients who received combined therapy (93.3%) was much higher than in those who received only systemic treatment (73.0%) (p < .05). In the combined treatment group, the success rate was similar between women who received locally injected KCl (95.2%) and those who received locally injected MTX (91.7%).ConclusionThe significantly higher success rate in patients who received combined US-guided local injection and systemic MTX suggests that this is an efficient nonsurgical option in women with tubal pregnancy, high serum β-human chorionic gonadotropin concentration, and fetal cardiac activity.     

输卵管妊娠治疗现状与趋势

由于定量测定 HCG水平和阴道超声的应用 ,大约 80 %异位妊娠可以在破裂前得到早期诊断 ,因此 ,治疗倾向于保守性。甲氨蝶呤 (MTX) 1mg/ m2 单次肌内注射总成功率达 88% ,对大约 4 0 %患者可作为首选方案。多次注射方案成功率略高于单次注射 ,但副反应发生率明显升高。腹腔镜下输卵管线形切开造口术 (开窗术 )已成为治疗输卵管妊娠的标准保守性手术。若对侧输卵管异常 ,患侧输卵管行保守性治疗虽稍增加重复异位妊娠的发病率 ,但在一定程度上也能提高宫内孕率     

Laparoscopic Versus Laparotomy Treatment of Ectopic Pregnancy: A Canadian Perspective

In order to determine if hospital stay, costs, and narcotic requirement are reduced in patients with laparoscopic versus laparotomy management of ectopic pregnancy (EP), a retrospective review was undertaken of 64 EPs treated surgically at the Ottawa Civic Hospital. One hundred and sixty-four patients were treated (48 operative laparoscopy; 116 laparotomy). Laparotomies were performed through a Pfannensteil incision. Laparoscopic surgery was performed through a subumbilical incision after achieving a pneumoperitoneum with carbon dioxide. Two suprapubic 5mm auxiliary puncture sites were used for instxumentation. Laparoscopic cases were compared to laparotomies with respect to postoperative hospital stay, mean cost of stay, postoperative complications, blood loss, and postoperative narcotic usage. Postoperative hospital stay was found to be shorter and as a result costs three times less after laparoscopic versus laparotomy treated EP. Postoperative pain and total blood loss is less after laparoscopy; therefore, laparoscopic management of EP is preferable to traditional laparotomy.     

甲氨蝶呤联合米非司酮或中药治疗异位妊娠的疗效观察

目的:观察甲氨蝶呤(MTX)联合米非司酮或中药治疗输卵管妊娠的疗效。方法:A组:MTX单次肌内注射并口服米非司酮,B组:MTX单次肌内注射并口服中药,对照组:MTX(50 mg/m2)单次肌内注射。定期监测血-βHCG水平及阴道B超监测包块情况直至正常。结果:治愈率A组82.1%、B组81.2%对照组72.5%,A、B两组较对照组明显缩短血-βHCG降至正常所需的时间,减少住院日(P<0.01),A、B两组间没有明显的差异(P>0.05),但B组副反应明显比A组少(P<0.05)。结论:MTX单次肌内注射联合中药治疗输卵管妊娠疗效好、副反应少,值得临床推广。     

剖宫产后切口妊娠的临床诊治分析

目的:研究剖宫产后子宫切口妊娠的临床表现及治疗方法等特征,为临床医生早期诊断、早期处理本病提供依据。方法:对25例患者的病史、临床表现、诊断方法以及治疗方法进行回顾性分析。结果:25例患者中有23例经阴道超声检查或彩色多普勒超声检查确诊;本病初诊误诊19例,误诊率76%,25例患者中保守治疗22例,21例痊愈,占95.45%;2例治疗失败而行全子宫切除术。结论:有剖宫产史的妇女因停经就诊时,要常规行阴道超声检查,对阴道超声怀疑切口妊娠的病例,有必要行彩色多普勒超声检查;彩色多普勒超声检查可作为诊断切口妊娠的主要方法;甲氨蝶呤加清宫术可作为治疗切口妊娠的主要方法,可有效地避免子宫切除。