腹腔镜保守性手术联合米非司酮与甲氨蝶呤治疗异位妊娠效果分析

目的：探讨异位妊娠行腹腔镜保守性手术联合米非司酮和甲氨蝶呤（MTX）的可行性、治疗效果及安全性。方法：364例异位妊娠患者进行了腹腔镜保守性手术治疗,A组302例术中使用MTX30mg病灶局部注射,术后使用米非司酮口服;B组52例单纯于术后口服米非司酮。结果：所有患者手术均用腹腔镜顺利完成,手术时间15～70min,平均30min;术中出血1～50ml,平均10ml;平均住院4d;无严重并发症发生。A组无持续性异位妊娠（PEP）发生,B组发生PEP2例。A组术后米非司酮最大使用剂量1900mg,除月经复潮时间延迟,月经量稍增多,未发现其他副作用。结论：腹腔镜保守性手术联合米非司酮与甲氨蝶呤治疗异位妊娠具有创伤小、康复快、PEP发生率低、副作用小的优点,值得推广。

The effect analysis of laparoscopic conservative surgery combined with Mifepristone and MTX in the treatment of ectopic pregnancy

Objective：To explore the feasibility,therapeutic effect and safety for laparoscopic conservative surgery combined with Mifepristone and MTX in the treatment of ectopic pregnancy. Methods：364 ectopic pregnancy patients were chosen and conservatively operated with laparoscopic conservative surgery,A group of 302 patients was injected with MTX 30 mg in local lesion and followed by oral Mifepristone,B group of 52 patients took Mifepristone alone after the operation. Results：All cases had been operated successfully with laparoscopy. The operative time was 15-70 min,the mean operating time was 30min; the bleeding was 1-15 ml,the mean bleeding was 10 ml; the average hospitalization was 4 d; no severe complications occurred. No persistent ectopic pregnancy （PEP） occurred in A group,2 cases developed PEP in B group. The highest dose of Mifepristone in A group was 1 900 mg,except menstruation delayed and the amount of menstruation increased slightly,no other side effects were found. Conclusion：Laparoscopic conservative surgery combined with Mifepristone and Methotrexate in the treatment of ectopic pregnancy is less trauma,faster recovery,lower incidence of PEP and side effects are small. It is worth generalizing.