摘要
目的:探讨药物保守治疗、开腹手术、腹腔镜手术不同方案对异位妊娠患者影响.方法:回顾性分析2016年3月至2019年3月本院收治的80例异位妊娠患者临床资料,根据治疗方式不同,分为保守治疗组(米非司酮+甲氨蝶呤+杀胚方剂)30例,开腹组(开腹输卵管切除术)30例,腹腔镜组(腹腔镜下输卵管切除术)20例,治疗后1周,比较三组血清 β-人绒毛膜促性腺激素(β-hCG)、孕酮(P)、血管内皮生长因子(VEGF)水平,通过患者血清指标、影像结果评价临床疗效;监测三组治疗后不良反应或并发症,比较三组住院时间及住院费用;治疗后3个月,采用焦虑(SAS)、抑郁(SDS)自评量表评价心理状态,女性性功能指数评估量表(FSFI)评价性功能.结果:治疗后1周,开腹组、腹腔镜组血清β-hCG、P及VEGF水平均显著低于保守治疗组(P<0.05),但开腹组与腹腔镜组无显著差异(P>0.05);开腹组与腹腔镜组显效率均为100.00%,显著高于保守治疗组的63.33%(P<0.05);三组不良反应或并发症发生率无显著差异(P>0.05);保守治疗组住院时间显著长于开腹组、腹腔镜组(P<0.05),住院费用显著低于开腹组、腹腔镜组(P<0.05);治疗后3个月,保守治疗组SAS、SDS评分降低幅度大于开腹组(P<0.05),FSFI评分降低幅度小于开腹组(P<0.05),但与腹腔镜组无显著差异(P>0.05).结论:手术治疗异位妊娠患者,能更快改善患者血清β-hCG、P及VEGF水平,早期疗效优于保守治疗,但保守治疗在住院费用、治疗后心理状态及性功能状态方面优于手术治疗,且手术治疗与药物治疗均有较好的安全性,临床应结合实际情况予以个体化治疗.
Objective:To explore the effects of conservative medication,open surgery and laparoscopic surgery on patients with ectopic pregnancy.Methods:The clinical data of 80 patients with ectopic pregnancy admitted to the hospital from March 2016 to March 2019 were retrospectively analyzed.According to different treatment methods,they were divided into conservative medication group(mifepristone+methotrexate+Shapei prescription,30 cases),open group(openfallopian tube resection,30 cases)and laparoscopic group(laparoscopic fallopian tube resection,20 cases).At 1 week after treatment,the levels of serumβ-human chorionic gonadotropin(β-hCG),progesterone(P)and vascular endothelial growth factor(VEGF)were compared among the three groups,and the clinical efficacy was evaluated by serum indexes and imaging results.The adverse reactions or complications were monitored in the three groups after treatment.The hospital stay and hospitalization expense were compared among the three groups.At 3 months after treatment,the psychological states of the patients were evaluated by Self-rating Anxiety Scale(SAS)and Self-rating Depression Scale(SDS),and the sexual function was evaluated by Female Sexual Function Index(FSFI).Results:At 1 week after treatment,the levels of serumβ-hCG,P and VEGF in open group and laparoscopic group were significantly lower than those in conservative medication group(P<0.05),but there were no significant differences between open group and laparoscopic group(P>0.05).The efficacy was 100.00%in open group and laparoscopic group,which was significantly higher than that in conservative medication group with 63.33%(P<0.05).There were no significant differences in the incidence rates of adverse reactions or complications among the three groups(P>0.05).The hospital stay in conservative medication group was significantly longer than that in open group and laparoscopic group(P<0.05),and the hospitalization expense was significantly lower than that in open group and laparoscopic group(P<0.05).At 3 months after treatment,the reductions of SAS and SDS scores in conservative medication group were greater than those in open group(P<0.05)while the decrease of FSFI score was smaller than that in open group(P<0.05),but there were no significant differences compared with those in laparoscopic group(P>0.05).Conclusion:Surgical treatment of patients with ectopic pregnancy can improve serumβ-hCG,P and VEGF faster,and its early efficacy is better than conservative treatment,but conservative treatment is superior to surgical treatment in hospitalization expense and psychological states and sexual function status after treatment.And surgical treatment medication have better safety,and it is necessary to take individualized treatment by combining with the actual situation in clinical practice.
作者
李凡
王如萍
周萍
LI Fan;WANG Ruping;ZHOU Ping(The First People's Hospital of First Affiliated Huainan Anhui University of Science and Technology,Anhui Huainan 232007,China)
出处
《河北医学》
CAS
2020年第7期1092-1097,共6页
Hebei Medicine
基金
安徽省自然科学基金,(编号:1308085MH148)。
关键词
异位妊娠
开腹手术
腹腔镜手术
Ectopic pregnancy
Open surgery
Laparoscopic surgery
