3种保守治疗方法治疗输卵管妊娠的应用价值

目的探讨3种保守方法治疗输卵管妊娠(TP)的疗效及其在临床中的应用价值。方法选择2005年10月至2010年8月在本院就诊并确诊为TP的274例患者为研究对象。将其按就诊顺序随机分为3组,分别接受3种方式治疗:介入组(n=94),MTX(甲氨蝶呤)组(n=89)及5-Fu(氟尿嘧啶)组(n=91)。分别比较3种保守治疗方式的疗效、不良反应发生率、住院费用和时间等。对有生育要求者分别于治疗结束半年后行输卵管碘油造影(HSG),了解输卵管通畅度及生育情况(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试者的知情同意,并与其签署临床研究知情同意书)。3组患者的年龄、停经时间、治疗前血清β-人绒毛膜促性腺激素(hCG)水平、阴道流血时间和孕囊直径比较,差异无统计学意义(P>0.05)。结果介入组治疗成功率(100.00%,94/94)明显高于MTX组(75.28%,67/89)及5-Fu组(79.12%,72/91),组间比较,差异有统计学意义(P<0.01)。各组治疗后要求保留生育功能的患者,于治疗结束半年后进行患侧输卵管HSG,3组输卵管通畅率(阻塞率)比较,差异无统计学意义(P>0.05),但介入治疗对生育功能的影响最小,3组患者生育功能比较,差异有统计学意义(P<0.01)。结论 3种保守治疗方法对TP的治疗均有一定效果。其中,介入治疗的疗效最好,但对设备及技术要求更高,费用亦高,在基层医院难于推广。故MTX肌内注射及5-Fu静脉滴注治疗TP,仍是基层医院治疗TP的较好方法。

Application Value of Three Kinds of Methods of Conservative Treatment on Tubal Pregnancy

Objective To explore three kinds of conservative methods to treat tubal pregnancy(TP) and its application value in clinical effe cts.Methods A total of 274 patients who were diagnosed as TP from Oct ober 2005 to August 2010 in our hospital were included into this study.They wer e divided into three groups randomly and received three kinds of treatment metho ds,intervention group(n=94),MTX(methotrexate) group(n=89) and 5-Fu(fluorouracil) group(n=91).The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Affiliated Hospital of North Si chuan Medical College.Informed consent was obtained from each patient.Curative effects,adverse effects,expenses and hospitalized time were compare d among three groups.After half a year of the treatment,patients with fertilit y requirement underwent hysterosalpingogram(HSG) requirements at sixth month after operation,in order t o find out o viduct tubes unobstructed degrees.There had no significant difference among thr ee groups on patients’ age,menopause time,serum β-hCG level before treatmen t,vag inal bleeding time and pregnant capsule diameter(P>0.05).Results The successful rate in intervention group(100.0 0%,94/94) was significantly higher than that of MTX group(75.28%,67/89) and 5-Fu group(79.12%,72/91)(P<0.01).There had no significant difference of tubal patency rate at sixth months after treatment among three groups(P>0.0 5).But intervention treatment had the minimal impact on reproductive functions.There had significant difference of reproductive function among three groups(P<0.01).Conclusions Three kinds of conservative treat ment of TP have certain effects.Among them,the curative effect of interventional t reatment is the best,but the equipment and technology requirements are higher,and the cost is also high.MTX(muscle injection) and 5-Fu(intravenous drip) a re still better methods in the treatment of TP at the basic-level hospital.