单纯腹腔镜保守性手术和腹腔镜联合氨甲喋呤治疗异位妊娠的疗效比较

目的：比较单纯应用腹腔镜保守性手术和腹腔镜保守性手术联合氨甲喋呤（MTX）治疗未破异位妊娠的疗效。方法：将我院2009年3月至2012年5月收治的65例有生育要求的未破裂型输卵管妊娠患者分别采用单纯腹腔镜保守手术（单纯手术组）和腹腔镜保守性手术联合氨甲喋呤（联合治疗组）进行治疗，其中单纯手术组32例，联合治疗组33例。观察两组患者的治愈率、血β-HCG下降至正常的时间和术后持续性异位妊娠的发生率。于1年半内观察随访宫内妊娠的成功率和异位妊娠复发率。结果：腹腔镜保守性手术联合氨甲喋呤治疗异位妊娠的治愈率高、住院时间短、血β-HCG降至正常的时间快且持续性异位妊娠的发生率低，差异有统计学意义（P＜0.05）。治疗后1年半内联合治疗组再次妊娠率显著高于单纯手术组，差异有统计学意义（P＜0.05）。结论：腹腔镜保守性手术联合氨甲喋呤治疗异位妊娠临床疗效确切，住院时间短，值得在临床上推广，作为有生育要求的异位妊娠患者的首选方案。

Curative effect of laparoscopic conservative operation and laparoscopy combined with methotrexate in treat-ment of ectopic pregnancy

Objectives：To compare the curative effect of simple laparoscopic conservative operation and laparoscopy combined with methotrexate （MTX）in the treatment of unruptured ectopic pregnancy.Methods：From March 2009 to May 201 2,65 unruptured tubal pregnancy cases in our hospital were selected,who all had fertility requirements and were treated with laparoscopic conservative operation （simple operation group,32 cases）or lapa-roscopy combined with methotrexate （combined treatment group,33 cases）.The cure rate,time needed for serumβ-HCG decreased to normal and the incidence rate of postoperative persistent ectopic pregnancy of the two groups were compared.In one and a half years’follow-up,the intrauterine pregnancy success rate and recurrence rate of ectopic pregnancy of both groups were compared.Results：In the treatment of ectopic pregnancy,laparoscopic con-servative operation combined with methotrexate had high cure rate,shorter hospitalization time,and the time for blood β-HCG to return to normal and the occurrence of persistent ectopic pregnancy rate was low,with statistically significant difference （P〈0.05）.One and a half years after treatment,the success rate of intrauterine pregnancy in the combined treatment group was significantly higher, with statistically significant difference （P〈0.05 ）. Conclusion：Laparoscopic conservative operation combined with methotrexate has better clinical curative effect and short hospitalization time in the treatment of ectopic pregnancy,which,as a first choice for patients with ectopic pregnancy,is worthy of clinical application.