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。
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.
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