米非司酮在宫外孕保守手术治疗中的临床观察

目的:探讨对输卵管妊娠行腹腔镜保守性手术前使用米非司酮,对减少保守手术中绒毛着床创面出血的作用以及预防持续宫外孕。方法:将确诊为异位妊娠B超下附件混合性包快<4cm,个别可见心管搏动,血β-HCG≥2000U/L,生命体征平稳,有腹腔镜保守手术指征的患者87例分为A、B两组,A组:术前1天口服米非司酮300mg,次日上午行腹腔镜保守性手术,术后继续服米非司酮300mg;B组:单纯行腹腔镜保守性手术,术毕手术创面给予局部注射MTX20mg;观察两组间绒毛着床创面出血的量,术前、术后β-HCG下降情况及再次妊娠结局情况。结果:A组中38例(86·36%)保守手术成功,6例(13·63%)因输卵管绒毛着床面出血多,止血困难行输卵管切除术;B组中32例(74·42%)保守手术成功,11例(25·58%)因输卵管绒毛着床面出血多,止血困难行输卵管切除术。术后随访:A组再次宫内妊娠22例(62·85%),再次异位妊娠5例(14·28%);B组再次宫内妊娠23例(62·16%),再次异位妊娠6例(15·78%),两组间无显著差异。结论:异位妊娠患者在血β-HCG≥2000U/L,腹腔内出血不多,生命体征平稳,密切观察生命体征变化下,先用米非司酮治疗24h后行腹腔镜下的保守手术,其保留输卵管成功率更高。术后再用米非司酮继续治疗可防止持续宫外孕发生。

Clinical study on mifepristone tablets used as conservative surgery treatment on ectopic pregnancy

Objective:To evaluate the effectiveness of administration of mifepristone combined with laparoscopy for tubal pregnancy on reduction in blooding of cilium implantation and prevention of ectopic pregnancy.Methods:Eighty-seven patients were diagnosised as tubal pregnancy, who has 4 cm dimension ectopic pregnancy masses, some of which the fetal heart can be seen, the titer of serumβ-HCG≥2 000 U/L.They were randomly divided into A and B group. Group A were given oral administration of mifepristone 300 mg the day before laparoscopy while group B laparoscopy only and after that, the pregnancy site were given MTX 20 mg injection. The amount of bleeding, the β-HCG reducing and the later pregnancy rate were observed.Results:In group A 38 cases (86.36%) were cured successfully; 6 cases (13.63%) were received salpingectomy for continually bleeding. In group B, 32 cases (74.42%) were cured successfully; only 11 cases (25.58%) were received salpingectomy for continually bleeding. The intrauterine pregnancy in group A was 22(62.85%)while that in group B was 23(62.16%);and ectopic pregnancy in group A was 5(14.28%)while that in group B was 6(15.78%),so there was no significant difference between group A and B.Conclusion:The patient who has the serum titer ofβ-HCG≥2 000 U/L, little bleeding and a good life condition is given mifepristone before laparoscopy will have a higher rate of oviduct reservation. The use of mifepristone can still reduce the rate of persistent ectopic pregnancy.