摘要
目的探讨甲氨蝶呤(MTX)不同给药方式联合微创手术治疗输卵管妊娠的临床效果。方法选择2015年10月至2017年6月新乡医学院第三附属医院收治的192例输卵管妊娠患者为研究对象,所有患者给予MTX联合微创手术治疗,根据MTX给药方式将患者分为术前肌肉注射组(n=48)、术中局部注射组、术后肌肉注射组(n=50)和术后静脉注射组(n=49)。术前肌肉注射组患者术前肌肉注射MTX(50 mg·kg^-1),2 d后行微创手术;术中局部注射组患者先行微创手术,取出孕囊后,将MTX溶于3 mL生理盐水中,于超声引导下在孕囊所在肌层局部注射(50 mg·kg^-1);术后肌肉注射组患者先行微创手术,手术结束时单次肌肉注射MTX(50 mg·kg^-1);术后静脉注射组患者先行微创保守手术,手术结束时将MTX溶于20 mL生理盐水中静脉注射(50 mg·kg^-1);4组患者均于术后12 h口服50 mg米非司酮,每日2次,连续3 d。比较各组患者手术时间、术中出血量、术后血清人绒毛膜促性腺激素(β-HCG)、血管内皮生长因子(VEGF)、抑制素A(INH-A)水平及再次妊娠时间、持续性异位妊娠(PEP)发生率、输卵管通畅率、不良反应发生率。结果术前肌肉注射组患者手术时间短于术中局部注射组、术后肌肉注射组和术后静脉注射组,术中失血量少于术中局部注射组、术后肌肉注射组和术后静脉注射组(P<0.05)。术前肌肉注射组患者术后血清β-HCG、VEGF、INH-A水平低于术中局部注射组、术后肌肉注射组和术后静脉注射组(P<0.05)。术前肌肉注射组患者再次妊娠时间短于术后肌肉注射组和术后静脉注射组(P<0.05);术前肌肉注射组与术中局部注射组患者再次妊娠时间比较差异无统计学意义(P>0.05)。术前肌肉注射组患者输卵管通畅率高于术中局部注射组、术后肌肉注射组和术后静脉注射组(P<0.05);术前肌肉注射组患者PEP发生率低于术中局部注射组、术后肌肉注射组和术后静脉注射组;术前肌肉注射组、术中局部注射组、术后肌肉注射组、术后静脉注射组患者并发症发生率分别为4.17%(2/48)、6.67%(3/45)、4.00%(2/50)、18.37%(9/49);术后静脉注射组患者不良反应发生率高于术前肌肉注射组、术中局部注射组和术后肌肉注射组(χ^2=4.863、4.401、5.172,P<0.05)。结论MTX术前肌肉注射联合微创手术治疗输卵管妊娠手术时间短、术中失血量少、输卵管通畅率高、PEP发生率低。
Objective To investigate the effect of different routes of methotrexate(MTX)combined with minimally invasive surgery for tubal pregnancy.Methods A total of 192 patients with tubal pregnancy admitted to the Third Affiliated Hospital of Xinxiang Medical University from October 2015 to June 2017 were selected as study objects.All patients were given MTX and minimally invasive surgery,the patients were divided into preoperative intramuscular injection group(n=48),intraoperative local injection group(n=45),postoperation intramuscular injection group(n=50)and postoperation intravenous injection group(n=49)according to different routes of administration of MTX.The patients in the preoperative intramuscular injection group were given intramuscular injection of MTX(50 mg·kg^-1)before operation,then they were performed with minimally invasive surgery two days later.The patients in the intraoperative local injection group were given minimalsy invasive surgery firstly,after moving the pregnant bursa,the MTX was dissolved in 3 mL saline and it was injected into muscular layer locally where the pregnant bursa was(50 mg·kg^-1).The patients in the postoperation intramuscular injection group were given minimally invasive surgery firstly,then they were given MTX(50 mg·kg^-1)for single intramuscfular injection at the end of the operation.The patients in the postoperation intravenous injection group were given minimally invasive surgery firstly,the MTX was dissolved in 20 mL saline and it was given to the patients by intravenous injection(50 mg·kg^-1)at the end of the operation.All patients in the four groups took 50 mg MTX orally 12 hours after surgery,twice a day for three consecutive days.The operative time,intraoperative blood loss,serum human chorionic gonadotropin(β-HCG)level,serum vascular endothelial growth factor(VEGF)level,inhibin A(INH-A)level,re-pregnancy time,and incidence of persistent ectopic pregnancy(PEP),tubal patency rate and incidence of adverse reactions were observed and compared in each group.Results In the preoperative intramuscular injection group,the operation time was shorter and the intraoperative blood loss was lower than that in the intraoperative local injection group,postoperation intramuscular injection group and postoperation intravenous injection group(P<0.05).The levels ofβ-HCG,VEGF and INH-A in the preoperative intramuscular injection group were lower than those in the intraoperative local injection group,postoperation intramuscular injection group and postoperation intravenous injection group(P<0.05).The re-pregnancy time in the preoperative intramuscular injection group was shorter than that in the postoperation intramuscular injection group and postoperation intravenous injection group(P<0.05).There was no significant difference in the re-pregnancy time between the preoperative intramuscular injection group and the intraoperative local injection group(P>0.05).The tubal patency rate in the preoperative intramuscular injection group was higher than that in the intraoperative local injection group,postoperation intramuscular injection group and postoperation intravenous injection group(P<0.05).The incidence of PEP in the preoperative intramuscular injection group was lower than that in the intraoperative local injection group,postoperation intramuscular injection group and postoperation intravenous injection group(P<0.05).The complication rate of the preoperative intramuscular injection group,intraoperative local injection group,postoperation intramuscular injection group and postoperation intravenous injection group was 4.17%(2/48),4.44%(2/45),4.00%(2/50)and 18.37%(9/49),respectively.The complication rate in the postoperation intravenous injection group was higher than that in the preoperative intramuscular injection group,intraoperative local injection group and postoperation intramuscular injection group(χ^2=4.863,4.401,5.172;P<0.05).Conclusion Preoperative intramuscular injection of MTX combined with minimally invasive surgery in the treatment of tubal pregnancy has short operation time,less intraoperative blood loss,high rate of tubal patency and low incidence of PEP.
作者
何全中
李慧智
张花
王志景
HE Quan-zhong;LI Hui-zhi;ZHANG Hua;WANG Zhi-jing(Department of Obstetrics and Gynecology,the Third Affiliated Hospital of Xinxiang Medical University,Xinxiang 453003,Henan Province,China)
出处
《新乡医学院学报》
CAS
2019年第12期1167-1170,共4页
Journal of Xinxiang Medical University
关键词
输卵管妊娠
甲氨蝶呤
给药途径
微创手术
人绒毛膜促性腺激素
输卵管通畅率
tubal pregnancy
methotrexate
route of administration
minimally invasive surgery
human chorionic gonadotropin
tubal patency rate
