不同方案保守治疗输卵管妊娠临床分析

目的:探讨副作用小、成功率高的输卵管妊娠保守治疗方法。方法:对未破裂输卵管妊娠362例,根据甲氨蝶呤(MTX)不同剂量、给药途径以及是否联合应用米非司酮分成5组:MTX100mg,静脉推注(组1);MTX用法同组1,同时口服米非司酮50mg,每日2次,连用3天(组2);MTX100mg分5天静脉推注,米非司酮用法同组2(组3);MTX75mg静脉推注,米非司酮用法同组2(组4);MTX75mg肌注,米非司酮用法同组2(组5)。上述5组治疗1周,血β-hCG下降<15%,可再行第2疗程治疗。比较5组第2疗程治疗率、成功率及副反应。结果:组2~组5治愈率明显高于组1,各组治愈率,第2疗程治疗率无显著性差异(P>0·05)。组1~组5谷丙转氨酶(ALT)异常发生率分别为10·4%、9·6%、64·0%、8·2%、30·9%,组3和组5明显高于其他组,比较各组差异有显著性意义(P<0·05)。血β-hCG下降至正常时间组2~组5较组1明显短,比较各组差异有显著性(P<0·05)。结论:MTX联合米非司酮治疗输卵管妊娠治愈率高,血β-hCG下降至正常时间短,MTX75mg静脉推注联用米非司酮副反应发生率低,可作为首选方案。

A Study on Different Conservative Treatment for Unruptured Tubal Ectopic Pregnancy

Objective: To evaluate the safety and efficacy method as the conservative treatment for unruptured tubal ectopic pregnancy. Methods: A total of 362 cases of unruptured tubal ectopic pregnancy were divided into 5 groups according to different protocol of methotrexate (MTX) treatment, and combined with oral mefepristone at the dose of 50 mg twice daily for a total of 3 days or not. Group 1: a single dose of 100mg of MTX intravenous injection; Group2: the same as Group 1, but combined with oral mefepristone; Group 3: 100mg of MTX intravenous injection for 5 days combined with oral mefepristone; Group 4: a single dose of 75mg of MTX intravenous injection combined with oral mefepristone; Group 5: a single dose of 75mg of MTX intramuscular injection combined with oral mefepristone. The second period of treatment should be administered if the serum β-hCG concentration at the 7th Day declined 15 percent. Compare the repeated administered rate, success rate, and side effects. Results: The curative rate is significantly higher in Group 2-5 than Group 1(P<0.05). It showed no statistical difference among Group 2-5 in curative rate, repeated administered rate (P>0.05). A statistical difference was observed in the abnormal rate of Alanine Aminotransferase(ALT ) in Group 2-5 (P>0.05), and ALT was significantly higher in Group 3 and 5. The duration that the serum β-hCG concentration declined to normal was shorter in Group 2-5 than in Group1 (P<0.05). Conclusion: MTX combined with mefepristone is safe and effective in the conservative treatment for unruptured tubal ectopic pregnancy, especially the protocol of “a single dose of 75mg of MTX intravenous injection combined with oral mefepristone” is preferred.