单剂氨甲喋呤治疗异位妊娠75例临床观察

目的 :探讨单剂氨甲喋呤 (MTX)肌注治疗异位妊娠的适应症、临床效果及输卵管再畅和受孕情况。方法 :对 75例异位妊娠患者采用 MTX单剂肌注 (5 0 m g/ m2 ) ,不用四氢叶酸解毒方案治疗 ,定时监测血β- h CG直至正常 ,同时查血孕酮 ,B超检查异位妊娠包块直径大小及消失时间 ,治疗后作输卵管通液术或造影术。结果 :70例成功 ,成功率 93% ,成功与失患者孕龄、异位妊娠包块直径大小无显著差异性 ,与治疗前腹痛症状的发生率及血β- h CG值间的差异有显著性 ,输卵管再畅率 91.4% ,宫内妊娠率 11.4% ,再次异位妊娠率 1.4%。结论 :单剂氨甲喋呤治疗异位妊娠适用于无腹痛症状 ,异位妊娠包块直径≤ 3.5 cm、血β-h CG<5 0 0 0 Iu/ L的病列 ;此法输卵管再畅率较高 ,适用于需要保留生育能力的患者。

Clinical Study on 75 Cases of Ectopic Pregnancy with single-dose Intramuscular Methotrexate Treatment

Objective: To investigate the indication and Clinical efficacy of single dose intramuscular methotrexate to treat ectopic pregnancy, and the effects of drug treatment on recanalization of oviduct and becoming pregnancy. Methods: seventy five cases of ectopic pregnancy were treated by singal-dose intramuscular methotrexate(50mg/m 2) without tetrahydrofolic acid rescues. The β-hCG was monitored regularly till it became normal. The ultrasonography was used to estimate the size of adnexal ectopic mass till the mass dissappeared. Then the tubal patent test was made by liquid instillation salpingography. Results: Seventy cases(93%) were successfully treated. There were no significant difference (P>0.05) in gestational age and size of adnexa ectopic mass between successful cases and failed cases, but significant differences P>0.05 in occurrence rate of abdominal pain and β-hCG titers before treatment. The oviduct recanalization rate was 91.4%. The rate of uterogestation was 11.4%, the rate of second ectopic pregnancy was 1.4%. Conclusion: The key to successful manegement is to strict criteria. Drug treatment is applicable to those who had no abdominal pain, ectopic mass≤3.5cm in greatest dimension and titer of serum β-hCG<5000IU/L, and the rate of recanalization of oviduct is relatively high, which favor the patients who require to restore the generational function.