甲氨蝶呤联合米非司酮治疗异位妊娠148例分析

目的:探讨甲氨蝶呤联合米非司酮治疗异位妊娠的效果和适应证。方法:将2002年1月～2006年7月在本院行保守治疗的异位妊娠妇女148例按孕周分为A组(<7孕周)33例,B组(7～8孕周)82例,C组(>8孕周)33例。每组又按血β-hCG值分为血β-hCG200～1000U/L(34例)、1000～5000U/L(83例)、>5000U/L(31例)3种情况,予甲氨蝶呤(150mg)联合米非司酮(600mg)治疗,观察治疗效果及其与孕周及血β-hCG值的关系。结果:A、B、C3组治疗成功率分别为90.90%、80.48%、69.69%,差异无显著性意义(P>0.05),血β-hCG200～1000U/L、1000～5000U/L者治疗成功率分别为94.11%、85.54%,明显大于血β-hCG>5000U/L者的51.61%,差异有显著性意义(P<0.01),A、B、C组有生育要求者治疗成功后输卵管碘油造影通畅率分别为85.71%(12/14)、85.71%(24/28)、76.92%(10/13),差异无显著性意义(P>0.05);血β-hCG200～1000U/L、1000～5000U/L、>5000U/L者通畅率分别为86.66(13/15)%、83.33%(25/30)、80%(8/10),差异无显著性意义(P>0.05)。治疗失败29例(19.59%),均行开腹或腹腔镜手术。结论:甲氨蝶呤联合米非司酮治疗异位妊娠效果显著,治疗适应证选择应综合考虑孕周与血β-hCG情况,在严密观察情况下,适当放宽治疗适应证是可行的。

Analysis of Treatment of 148 Cases of Ectopic Pregnancy with Methotrexate Combined Mifepristone

Objective: To probe into the treatment effect of ectopic pregnancy with methotrexate combined mifepristone and indications. Methods: 148 cases of women with ectopic pregnancy who needed conservative treatment from January 2002 to July 2006 were divided into three groups by gestational weeks: groupA(<7weeks, 33cases), groupB(7-8 weeks, 82 cases) , group C(> 8 weeks, 33cases). Each group was divided into three conditions by blood β-hCG value as well which ranged of 200-1000IU/L(34cases), 1000-5000 IU/L(83cases) and >5000IU/L(31cases), and treated with methotrexate(150mg) combined mifepristone(600mg). Effects of treatment were observed and their relationship with gestational weeks and β-hCG values were analyzed. Results: The treatment success rates of A, B,and C groups were 90.90%, 80.48% and 69.69%, respectively, which showed no significant difference(P>0.05). The treatment success rates of ones whose blood β-hCG values ranged of 200~1000IU/L (94.11%) and 1000~5000 IU/L (85.54%) were significantly higher than that of ones whose β-hCG value was > 5000 IU/L (51.61%)(P<0.01). After successful treatment, tubal patency rates at hysterosalpingo(HSG) of three groups(A,B and C) who desired for birth were 85.71% (12/14), 85.71% (24/28) and 76.92% (10/13), respectively, which showed no significant difference(P>0.05). Tubal patency rates at HSG of ones whose blood β-hCG values ranged of 200~1000IU/L, 1000~5000 IU/L and > 5000 IU/L were 86.66% (13/15), 83.33% (25/30) and 80% (8 /10), respectively, which showed no significant difference(P>0.05). 29 cases were failed in treatment which accounted for 19.59% underwent laparotomy or laparoscopy. Conclusion: Treatment effect of ectopic pregnancy with methotrexate combined mifepristone is significant. The gestational weeks and blood β-hCG should be considered for the selection of indications. It is feasible to widen treatment indications under the strict observation.