腹腔镜手术联合大剂量甲氨蝶呤保守治疗宫外孕的临床研究

目的:探讨腹腔镜联合大剂量甲氨蝶呤(MTX)治疗宫外孕的临床疗效及安全性。方法:76例宫外孕患者随机分为治疗组(36例)和对照组(40例)。治疗组采用腹腔镜手术联合大剂量MTX治疗,对照组采用大剂量MTX治疗。连续治疗14天后评价临床疗效,观察治疗后第7天血β-HCG下降率,观察血β-HCG下降至正常所需要时间及宫内妊娠率。结果:治疗组临床疗效总有效率为97.2%,显著高于对照组(P0.05);治疗后第7天治疗组血β-HCG下降率显著高于对照组,相比较有统计学差异(P0.05);治疗组血β-HCG下降到正常所需要的时间显著低于对照组,相比较有统计学差异(P0.05);治疗组1、2、3年的宫内妊娠率显著,分别为41.7%、61.1%、77.8%,显著高于对照组(P0.05);两组均无明显不良反应。结论:腹腔镜手术联合大剂量MTX保守治疗宫外孕的疗效确切、安全、可靠,值得临床上推广应用。

Clinical study of laparoscopic conservative surgery combined with high - dose meth-otrexate treatment of ectopic pregnancy

Objective:To evaluate the clinical efficacy and safety of laparoscopic combined with high dose methotrexate (MTX) treatment of ectopic pregnancy.Methods:76 patients with EP were randomly divided into treatment group (36 cases) and control group (40 cases).The treatment group was treated with laparoscopic surgery and high-dose MTX treatment,the control group was treated with high-dose MTX.After 14 days of continuous treatment the clinical efficacy was evaluated. In the 7th day after treatment the decline rate of serum β-HCG,the time-consuming of serum β-HCG decreased to normal levels and intrauterine pregnancy (IUP) rate were observed.Results:The clinical total effective rate of the treatment group was 97.2%,it was significantly higher than that of the control group (P<0.05). In the 7th day after treatment the decline rate of serum β-HCG of treatment group was significantly higher than that of the control group (P<0.05),the time-consuming of serum β-HCG decreased to normal levels in the treatment group was significantly lower than that in the control group (P<0.05); the IUP rate of the treatment group in the 1,2,3-year was respectively 41.7%,61.1% and 77.8%,they were significantly higher than that of the control group (P<0.05).There were no obvious side effects in the two groups.Conclusion:The conservative treating EP with laparoscopic combined with high dose methotrexate (MTX) has curative effect,it is safe,reliable and worthy of clinical application.