腹腔镜切开取胚术中联合甲氨蝶呤治疗异位妊娠的临床效果及对预后的影响评价

doi:10.3969/j.issn.2095-378X.2022.03.010

摘要/Abstract

摘要： 目的探讨腹腔镜下切开取胚术中联合甲氨蝶呤治疗异位妊娠的临床效果及对预后的影响。方法选择阳江市阳东区人民医院2018年4月—2021年3月收治的异位妊娠90例,采用随机数字表法分为对照组与观察组（45例/组）,对照组采用腹腔镜治疗,观察组则联合甲氨蝶呤治疗,观察两组治疗效果、血人绒毛膜促性腺激素（β-HCG）浓度恢复正常时间、术后腹痛率、输卵管通畅情况及住院时间,两组患者随访12个月,比较自然妊娠率与异位妊娠复发率。结果观察组疗效总有效率高于对照组,差异有统计学意义（P<0.05）;观察组血β-HCG浓度恢复正常时间、术后腹痛率短于对照组,输卵管通畅率高于对照组,住院时间短于对照组,差异有统计学意义（P<0.05）;随访12个月后观察组自然妊娠率高于对照组,异位妊娠复发率低于对照组,差异有统计学意义（P<0.05）。结论腹腔镜切开取胚术中联合甲氨蝶呤治疗异位妊娠效果优于单纯腹腔镜手术,能够缩短血β-HCG浓度恢复正常时间,降低术后异位妊娠持续状态机率,提升输卵管再通率;随访结果提示腹腔镜手术术中联合甲氨蝶呤治疗异位妊娠效果有助于提升患者自然妊娠率,降低异位妊娠复发率。

关键词: 异位妊娠, 腹腔镜, 甲氨蝶呤, 疗效, 人绒毛膜促性腺激素, 妊娠, 复发

Abstract: Objective To investigate the clinical effect of laparoscopic surgery combined with methotrexate on ectopic pregnancy and prognosis. Methods A total of 90 cases of ectopic pregnancy who were admitted to Yangdong District People's Hospital of Yangjiang City from April 2018 to March 2021 were selected and divided into a control group and an observation group （45 cases each group） by random number table method. The control group received laparoscopic treatment, and the observation group received laparoscopic treatment in combination with methotrexate. Treatment effect, blood human chorionic gonadotropin （β-HCG） recovery time, postoperative abdominal pain rate, tubal patency, and hospital stay were observed in the two groups. At 12 months of follow up, natural pregnancy rate and recurrence rate of ectopic pregnancy were compared between the two groups. Results The total effective rate of curative effect in the observation group was higher than that in the control group （P<0.05）. The β-HCG recovery time, postoperation abdominal pain rate, and length of hospital stay in the observation group were lower than those in the control group, and the tubal patency was higher （P<0.05）. After 12 months of follow-up, the natural pregnancy rate was higher and the recurrence rate of ectopic pregnancy was lower in the observation group than in the control group （P<0.05）. Conclusion Laparoscopic surgery combined with methotrexate in treating ectopic pregnancy is more effective than laparoscopic surgery only. It can shorten the time for blood β-HCG concentration to return to normal level, reduce postoperative abdominal pain rate, and improve the rate of tubal recanalization. The follow-up results suggest that laparoscopic surgery combined with methotrexate in the treatment of ectopic pregnancy can help improve natural pregnancy rate and reduce the recurrence rate of ectopic pregnancy.

Key words: Ectopic pregnancy, Laparoscopy, Methotrexate, Efficacy, Human chorionic gonadotropin, Pregnancy, Recurrence

中图分类号:

R713

刘宜恩, 吴夏筠, 谭福仙. 腹腔镜切开取胚术中联合甲氨蝶呤治疗异位妊娠的临床效果及对预后的影响评价[J]. 外科研究与新技术, 2022, 11(3): 183-186.

LIU Yi'en, WU Xiajun, TAN Fuxian. Clinical effect of laparoscopic surgery combined with methotrexate on ectopic pregnancy and prognosis[J]. Surgical Research and New Technique, 2022, 11(3): 183-186.

参考文献

[1] 顾海磊,唐文伟,陆小燕,等. MRI诊断罕见部位异位妊娠[J]. 中国医学影像技术,2021,37(4):573-576.
[2] 王豫红,朱兰. 异位妊娠期待治疗的进展[J]. 中华医学杂志,2021,101(7):524-526.
[3] 陈绪娇,闫凯麟,宋蓉蓉,等. 输卵管异位妊娠患者首诊超声图像特征结合血清β-hCG与临床治疗方式的关系研究[J]. 中国超声医学杂志,2021,37(7):806-810.
[4] 李朝光,顾玲玲,范冬燕,等. 不同麻醉方式对异位妊娠腹腔镜手术患者循环系统、苏醒时间影响[J]. 中国计划生育学杂志,2022,30(1):76-79.
[5] 黄杨琴,张徐,林以棠. 经脐单孔腹腔镜与三孔腹腔镜在异位妊娠手术的临床观察[J]. 浙江创伤外科,2022,27(1):67-68.
[6] 朱容,龙燕. 腹腔镜下微创治疗子宫内膜异位症合并不孕症妊娠结局及影响因素[J]. 中国计划生育学杂志,2021,29(7):1427-1430.
[7] 王蔚文,孙明.临床疾病诊断与疗效判断标准[M].北京:科学技术文献出版社,2010:797-798.
[8] 输卵管通畅性检查专家共识编写组. 输卵管通畅性检查专家共识[J]. 中华生殖与避孕杂志,2021,41(8):669-674.
[9] 中国优生科学协会肿瘤生殖学分会. 输卵管妊娠诊治的中国专家共识[J]. 中国实用妇科与产科杂志,2019,35(7):780-787.
[10] 应丽英,崔雪娜,丁洪琼. 甲氨蝶呤联合米非司酮治疗异位妊娠疗效及对血清人绒毛膜促性腺激素、癌抗原125、子宫内膜厚度的影响[J]. 中国基层医药,2021,28(3):415-420.
[11] 郭玉格,张海琴. 甲氨蝶呤单次与多次给药方案治疗异位妊娠的效果比较[J]. 医学临床研究,2021,38(4):604-606.
[12] 付一元,黄峥,王一斌,等. 对比分析腹腔镜复通术、简易复通术对输卵管绝育手术后再通的治疗效果[J]. 外科研究与新技术,2021,10(1):49-51,56.
[13] 杨洁,樊亚琴. 探讨输卵管妊娠腹腔镜手术保留输卵管后持续性异位妊娠发生的相关因素以及预防对策[J]. 中华养生保健,2021,39(18):24-26.
[14] 胡诗婉. 腹腔镜下手术联合应用甲氨蝶呤对异位妊娠患者生殖能力及生育结局的影响研究[J]. 陕西医学杂志,2019,48(12):1667-1669.
[15] 赵静,崔洁. 腹腔镜开窗取胚术结合甲氨蝶呤局部注射治疗异位妊娠[J]. 中国计划生育学杂志,2021,29(10):2048-2050,2055.
[16] 彭姬,周基莲,余昌娥,等. 甲氨蝶呤用于异位妊娠腹腔镜术后对患者性生活质量的影响[J]. 中国性科学,2021,30(10):85-88.
[17] 郭俊红. 腹腔镜下输卵管切开取胚术与垂体后叶素治疗输卵管妊娠的效果探究[J]. 医药论坛杂志,2020,41(10):126-128.
[18] 马俊丽. 腹腔镜妊娠部位输卵管纵轴切开取胚术后平行纵轴间断缝合在输卵管壶腹部妊娠患者中的应用观察[J]. 医学理论与实践,2021,34(4):651-653.