黄体剥除预防持续性异位妊娠临床分析

目的：观察对比黄体剥除术与甲氨喋呤（methotrexate，MTX）辅助防治输卵管妊娠腹腔镜保守性手术后持续性异位妊娠（persistent ectopic pregnancy，PEP）的疗效。方法：有生育要求的异位妊娠患者共86例，随机分成观察组44例，对照组42例。观察组腹腔镜下行胚胎清除术同时行黄体剥除术，对照组胚胎清除后局部注射甲氨碟呤20mg，未行黄体剥除。两组患者均于术前及术后24小时、72小时、7天、12天检测血B—bCG值，并观察其毒副反应。结果：观察组发生PEP1例（2．27％），对照组2例（4．76％），差异无显著性意义（x^2=0．395，P〉0．05）；两组术后24小时血B—hCG值较术前明显下降（P〈0.01），但两组间差异无显著性意义（P〉0．05）；术后72小时、7天血B-hCG值两组间差异无显著性意义（P〉0．05），但12天两组问比较差异有非常显著性意义，对照组明显高于观察组（P〈0．01）；且对照组毒副反应明显多于观察组。结论：黄体剥除术防治PEP的疗效与MTX相同，但黄体剥除术副作用小。

Clinical Study on Enucleation of Corpus Luteum to Prevent Persistent Ectopic Pregnancy

Objective:To compare the therapeutic efficacy of enucleation of corpus luteum to methotrexate adjuvant therapy on preventing persistent ectopic pregnancy(PEP) after laparoscopic conservative operation for tubal pregnancy.Methods:Eight-six patients with ectopic pregnancy who were eager to have a baby were randomly divided to observation group (n=44) and control group (n=42).Combined with laparoscopic removal of embryo,enucleation of corpus luteum was performed in the observation group and methotrexate of 20 mg was injected in the control group. The level of β-hCG was measured before operation and on day 1,3,7 and 12 after operation,and adverse events were observed.Results:The observation group had one (2.27%) case of PEP and the control group had 2 (4.76%) cases,with no significant difference (χ2=0.395,P>0.05).The level of β-hCG on the postoperative day 1 was decreased in both groups compared to that before operation (P<0.01),but no significant difference between the two groups (P>0.05); no difference was noted in the level of β-hCG on the postoperative day 3 and 7 between the two groups (P>0.05); On day 12,it was markedly higher in the control group than that in the observation group(P<0.01).The control group observed more adverse events.Conclusion:The therapeutic efficacy of enucleation of corpus luteum equals to MTX with less adverse effect.