输卵管妊娠腹腔镜输卵管线性切开术中甲氨喋呤应用的疗效观察

目的:比较腹腔镜输卵管妊娠保守手术和在该手术中加用患侧输卵管系膜内注射甲氨喋呤的疗效。方法:把128例腹腔镜下输卵管妊娠保守手术的患者随机等分成治疗组和对照组。对照组仅行腹腔镜下输卵管线性切开术输卵管妊娠产物清除术;治疗组手术同时于输卵管系膜内注射甲氨喋呤(methotrexate,MTX)30mg。术后随访监测血HCG下降水平、甲氨喋呤的副作用以及输卵管通畅情况。结果:治疗组与对照组持续性异位妊娠(persistent ectopic pregnancy,PEP)发生率分别为1.56%、16.36%,有显著性差异(P<0.01)。MTX的副作用以及输卵管通畅情况对比无显著性差异(P>0.05)。结论:腹腔镜输卵管线性切开手术治疗输卵管妊娠创伤小、术后恢复好,并可保留输卵管及生育功能;而在去除妊娠物后将小剂量MTX(30 mg)注入输卵管妊娠种植部位组织中可减少腹腔镜治疗后PEP的发生,且副作用小。

The Observation of Curative Effects of Application of MTX in Laparoscopic Linear Salpingostomy on Tubal Ectopic Pregnancy

Objective:To compare curative effects of laparoscopic salpingotomy conservative surgery and injecting MTX in affected side of mesosalpinx during laparoscopic salpingotomy conservative surgery for Tubal ectopic pregnancy.Methods:The 128 cases of patients who were applied tubal pregnancy laparoscopic salpingotomy conservative surgery were randomly divided into treatment and control groups. The control group applied tubal product dissection of tubal pregnancy in laparoscopic linear salpingostomy;The treatment group inject methotrexate(methotrexate,MTX) 30mg in affected side mesosalpinx on the basis of the control group treament.postoperative follow-up monitoring of decreased levels of HCG in blood,the side effects of methotrexate and tubal patency.Results:Persistent ectopic pregnancy (PEP) of the treatment group was 1.56%,PEP of the control group was 16.36%.there was a significant difference between treatment group and control group(P<0.01).side effects of MTX and tubal patency was no significant difference between treatment group and control group (P>0.05).ConcIusion:laparoscopic linear salpingostomy have the advantage of minimally invasive,postoperative recovery and reserves the fallopian tube and reproductive function to treat tubal ectopic pregnancy。injecting small dose of MTX(30 mg) into the organization of tubal pregnancy growing site can decrease the incidence of PEP,and it has few side effect.