氨甲喋呤单次肌肉注射治疗异位妊娠

探讨氨甲喋呤单次肌内注射治疗异位妊娠的效果及适应证。对２７例异位妊娠患者采用ＭＴＸ单次肌内注射，不同四氢叶酸解毒方案治疗。定量监测血β－ｈＣＧ直至正常。结果：２４例成功，成功率８８．９％。成功与失败患者的孕龄，异 妊娠包块直径间的差异无显著性，但治疗前腹痛症状的姓率及血β－ｈＣＧ值间的差异有非常显著性。     

宫腔镜下输卵管插管并注入氨甲喋呤治疗输卵管妊娠

宫腔镜下输卵管插管并注入氨甲喋呤治疗输卵管妊娠葛春晓丁慧娟马莉宫腔镜下采用输卵管插管注入５－氟尿嘧啶治疗输卵管妊娠，已有报道［１］。我院自１９９３年１２月至１９９５年５月，在宫腔镜下采用输卵管插管一次注入氨甲喋呤（ＭＴＸ）４０ｍｇ，共治疗输卵管妊娠１...     

彩色阴道超声引导局部注射氨甲喋呤治疗输卵管妊娠20例

彩色阴道超声引导局部注射氨甲喋呤治疗输卵管妊娠２０例孟英奇刘颖为开辟简捷、安全、疗效可靠、无损伤、无痛苦的药物治疗输卵管妊娠新途径，１９９６年１月始我们采用彩色阴道超声引导局部注射氨甲喋呤（ＭＴＸ）治疗输卵管妊娠２０例，获得了预期效果，报道如下。一、...     

氨甲喋呤单次静脉注射治疗异位妊娠63例分析

探讨氨甲喋呤单次静脉注射治疗异位妊娠的效果和适应证。方法对６３例患者随机分成Ａ、Ｂ两组。Ａ组３１例采用ＭＴＸ１００ｍｇ加生理盐水２０ｍｌ静注,不用甲酰四氨叶酸解毒。Ｂ组３２例应用同剂量ＭＴＸ后１２－２４小时内用ＣＦ１０－１２ｍｇ解毒。定期测血β－ｈＣＧ直至正常。     

口服氨甲喋呤治疗异位妊娠研究

注射氨甲喋呤(MTX)治疗异位妊娠的临床应用非常普遍,但由于治疗时间长,患者对多次注射难以接受,且存在药物的毒性作用问题。口服MTX的生物利用度为80％～85％,用量为60mg/m~2(注射剂量为50mg/m~ 2)。为评价口服MTX治疗异位妊娠的作用,对22例确诊为输卵管妊娠者进行研究,通过血hCG值、血浆孕酮测定联合阴道B超确诊。对异位妊娠包块大小<4cm(无胎心)或<3.5cm(有胎心)的情况稳定的患者,给予口服MTX治疗,用标准的25mg MTX片剂,按60mg/m~2分2次间隔2h给药。给药当天为第1d,分别在第4     

B超导向经腹局部注射MTX治疗输卵管妊娠17例分析

异位妊娠是一种妇科常见病,由于内出血危及病人生命,所以也是妇科急症之一。以往多采用手术治疗,８０年代初开始,由于尿、血β－ｈＣＧ测定、Ｂ超、腹腔镜技术的应用,使异位妊娠得到早期发现,为临床医生提供了保守治疗的机会。我院采用Ｂ超导向下,经腹穿刺将ＭＴＸ...     

电视腹腔镜治疗输卵管妊娠121例分析

异位妊娠是妇科常见急症之一 ,而输卵管妊娠占异位妊娠的 90 %以上[1] 。我院 2年间共行电视腹腔镜输卵管妊娠手术 12 1例 ,现总结如下。1　材料与方法1 1　一般资料　收集我院 1997年 1月至 1998年 12月间电视腹腔镜下诊断为输卵管妊娠并行手术治疗者 12 1例。年龄 2 1～ 45岁 ;49例未产妇 ,72例经产妇 ;有置环史 2 6例 ,腹部手术史 2 6例 ,盆腔炎史 8例 ,另 6 1例无不良既往史。1 2　术前诊断　除 10例术前诊断不明外 ,根据病史、症状、体征及辅助检查结果 ,其余 111例均在术前诊断为异位妊娠 ,诊断情况见表 1。停经时间为 36～ 90天不等 …     

甲氨蝶呤和米非司酮联合治疗非破裂型输卵管妊娠

目的探讨甲氨蝶呤(MTX)和米非司酮联合治疗非破裂型输卵管妊娠的效果。方法米非司酮300mg一次顿服,MTX20mg静注×5d。单用MTX的病人设为对照组。结果MTX和米非司酮联合治疗的成功率为87.5％,明显高于对照组。观察治疗期间病情变化,发现疗效与血β-hCG高低及有无心管搏动有关。结论MTX和米非司酮联合治疗非破裂型输卵管妊娠安全有效,适用于生命体征平稳、无剧烈腹痛、无心管搏动及血β-hCG＜30μg/L的非破裂型输卵管妊娠。     

Fertility outcomes subsequent to treatment of tubal ectopic pregnancy in younger Turkish women

Study Objective

The assessment of future fertility in patients that were hospitalized with diagnosis of tubal ectopic pregnancy.

Design

Between January 1998 and September 2008, we retrospectively reviewed 219 tubal ectopic pregnancy patients who were hospitalized. The patients using contraceptive methods, underwent previous pelvic or tubal surgery, pregnancy after in vitro fertilization, over the age of 28, and extratubal ectopic pregnancies were excluded. Patients who actively attempted to conceive were included. We called all the patients to see whether they had pregnancy in 24 months, and how long they had waited for this after the operation. Overall, we could not reach 14 patients who were treated surgically (n = 9) or medically (n = 5).

Setting

Department of Obstetrics and Gynecology, Ege University, Izmir, Turkey.

Participants

Women aged between 18 and 28 years that were treated because of tubal ectopic pregnancy and have concerns about infertility.

Interventions

Medical treatment with methotrexate (n = 34), salpingectomy (n = 62) salpingostomy (n = 37).

Main Outcome Measures

Intrauterine pregnancy rates, ectopic pregnancy rates and mean time to pregnancy after interventions.

Results

After questionnaire: in the methotrexate group; six of 29 (20%) had no pregnancy; 23 (79%) of them conceived, but three (10%) of the pregnancies were extrauterine. Thirty-seven patients received salpingostomy and 62 patients composed the salpingectomy group. Intrauterine pregnancy rates up to 24 months were established as 65.2% in salpingectomy (n = 55) and 60.1% in the salpingostomy (n = 35) groups respectively. No significant difference was noticed when pregnancy rates were compared among three groups (P = 0.942). Mean time to pregnancy in methotrexate group was 7.8 ± 2.2 months, and in salpingostomy and salpingectomy groups was 8.7 ± 2.2 and 9.3 ± 3.1 months respectively (P = 0.841).

Conclusion

Since we found no difference in terms of pregnancy rates among three groups, medical treatment appears to be more favored with early and accurate diagnosis. After salpingectomy, patients may conceive later in life when compared with other groups so selected patients should be assessed according to their age for the decision of assisted reproductive techniques.     

Unsuccessful treatment of tubal pregnancy by shock wave lithotripsy

A tubal pregnancy was unsuccessfully treated by means of a lithotrypter.     

Falloposcopy after prostaglandin treatment of tubal pregnancy

We report on a tubal pregnancy treated with prostaglandin F₂ locally. Falloposcopy two years afterwards showed multiple, non obstructive adhesions of the tubal epithelium.     

Predictors of failure of the commonly used single-dose methotrexate protocol for treating tubal ectopic pregnancies

Objectives

This study identified patients who would benefit from an earlier additional medical intervention and/or continuing close surveillance even if commonly used parameters indicated sufficient medical treatment to determine markers of treatment failure.

Comparison of multidose and single-dose methotrexate protocols for the treatment of ectopic pregnancy

OBJECTIVE: The purpose of this study was to compare success rates of 643 patients who had ectopic pregnancy from the same database who were treated with multidose or single-dose methotrexate protocols. STUDY DESIGN: We compared demographics, gestational age, serum human chorionic gonadotropin, progesterone levels, ectopic sac size and volume, overall ectopic mass size and volume, ectopic cardiac activity, history of ectopic pregnancy, number of treatment days, methotrexate doses, and outcome in consecutive patients with ectopic pregnancy who were treated with methotrexate. RESULTS: Success rates were comparable between patients with multidose and single-dose therapy (95% vs 90%, respectively) as were human chorionic gonadotropin and progesterone levels, history of ectopic pregnancy (21.4% vs 21.7%, respectively), number of treatment days, gestational age, ectopic size, ectopic volume, and ectopic mass volume. Patients who received single-dose therapy were significantly heavier (146 vs 159 pounds), had greater ectopic cardiac activity (3.1% vs 10.3%), and received fewer methotrexate doses. CONCLUSION: This study suggests single-dose methotrexate therapy is as effective as multidose methotrexate therapy for the treatment of ectopic pregnancy.     

甲氨蝶呤治疗输卵管妊娠后的生殖状态

目的 总结甲氨蝶呤(MTX)治疗输卵管妊娠后的生殖状态。方法 收集我院1997年3月-2002年8月确诊为输卵管妊娠并符合保守条件的患者6l例，应用MTX全身治疗，对其中46例随诊1-7年。结果 MTX治疗后宫内妊娠率71．7％，异位妊娠率8．7％。初孕即为输卵管妊娠者，保守治疗后宫内妊娠率为74．2％，再次异位妊娠率6．5％；第2次为输卵管妊娠者，保守治疗后宫内妊娠率为58．3％，再次异位妊娠率16．7％；第3次为输卵管妊娠者，保守治疗后无妊娠。结论 选择合适的早期患者采用MTX治疗是安全、价廉、可靠的治疗方法，也可获得满意的远期生殖状态。     

Single-dose methotrexate for the treatment of unruptured ectopic pregnancy

Objective The objective of this study was to review our experience with single dose intramuscular methotrexate (MTX) for the treatment of ectopic pregnancy and to evaluate major confounding factors that relate to the success of therapy.Patients and methods The selection criteria were patients who had a stable hemodynamic status and an ectopic gestational mass of <4 cm. on ultrasound. Patients were not excluded from MTX therapy either by a baseline serum -hCG titer or by the presence of fetal cardiac activity demonstrated on ultrasonography. Thirty- four of 86 patients diagnosed with ectopic pregnancy and treated with single-dose MTX between July 1999 and November 2001 were reviewed retrospectively.Results The mean pre-treatment -hCG level was 2,490±2,912 mIU/ml. Twenty-two patients (73.3%) were successfully treated with a single-dose of MTX. Eight patients (26.6%) required a second dose 1 week after the first injection and 2 patients received three doses. Thirty of the 34 patients (88%) were successfully treated with MTX. The mean pre-treatment -hCG level was significantly lower in patients who were successfully treated with MTX than in patients who failed MTX therapy (1,932±2,361 mIU/ml vs. 6,955±2,690 mIU/ml respectively, p<0.05). The mean pre-treatment serum -hCG level was higher in patients who had a second MTX injection as compared to patients who were successfully treated with a single injection of MTX (3,272±3,551 mIU/ml vs. 1,280±2,273 mIU/ml respectively, p>0.05). The mean time to resolution of -hCG was 26.5 days (10 to 37 days) with MTX. All 3 patients who failed medical therapy had -hCG level >4,000 mIU/ml and 2 of them had positive fetal cardiac activity.Conclusion In conclusion, this study showed that medical treatment of ectopic pregnancy with systemic single-dose methotrexate seems to be an option for some patients with unruptured tubal pregnancy.