甲氨蝶呤对预防持续性异位妊娠治疗方案的探讨

目的探讨甲氨蝶呤（MTX）用药途径及剂量对预防输卵管妊娠保守性手术后持续性异位妊娠（PEP）发生的效果，为临床提供实用的方案。方法将保守性手术治疗后的168例输卵管妊娠患者随机分成两组，A组（88例）术中给予MTX 20mg患侧输卵管系膜内注射；B组（80例）MTX 50mg术中肌内注射。所有患者均于术后1、4、7、11、14d测定血β—HCG，观察其下降情况及PEP的发生率、用药物后的毒副作用。结果术后24h血β-HCG值均较术前明显下降（〉50％），但两组间差异无显著性；术后4d两组间无明显差异，术后7、11天两组间差异显著（P〈0．01），A组所有患者于术后11d血β—HCG值均转阴（〈25IU／L），而B组在术后14d才转阴。A组无1例发生PEP，B组发生2例（2．5％），差异无显著性（P〉0．05）。B组中有15％（12／80）的患者出现了用药后的毒副反应。结论MTX 20mg术中注入患侧输卵管系膜内是预防持续性异位妊娠的实用、高效方案。

The discussion of treatment options on MTX in prevention of persistent ectopic pregnancy

Objective To explore the the effect of methotrexate（MTX） on preventing persistent ectopic pregnancy after conservative operation and to provide practical clinical treatment programmes. Methods 168 patients with tubal pregnancy who underwent conservative operation were divided into two groups randomly, group A（88） with MTX 20 mg local injection into fallopian tube lumen, and group B （80）with MTX 50 mg local injection. Serum β-HCG values was examined after operation and the occurrence of PEP or side reactionswere observed in all of patients Results There was 2 case of PEP in group B （2. 5% ）, while there was no one in group A, and the difference was not statistically significant（P 〉0. 05） . Serum β- HCG in both groups descended significantly in 24 hours after operation, and the difference was not statistically significant in 4 days; however the difference was statistically significant in the 7,11 days after operation （ P 〈 0. 01 ）. Serum β-HCG of group A turned into negative in 11 days（ 〈25IU/L）and while group B was in 14 days. The rate of the side reaction in group B was 15%. Conclusions MTX 20 mg local injection into fallopian tube lumen in preventing persistent ectopic pregnancy is effective and highly successful.