输卵管妊娠腹腔镜保守手术后甲氨蝶呤局部给药与肌肉注射的疗效比较
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摘要
目的观察输卵管妊娠腹腔镜下行保守手术后甲氨蝶呤局部给药与肌肉注射的疗效。方法将2011年3月至2013年12月期间我院接受腹腔镜手术治疗的未破裂输卵管妊娠患者80例纳入研究对象,进行输卵管开窗取胚手术,并随机分为腹腔镜下局部给药(观察组)与肌肉注射(对照组)两种甲氨蝶呤给药途径,比较两组患者术后的血清β-HCG水平、并发症发生率以及生活质量。结果术后3d、5d、7d时,观察组患者的血清β-HCG水平(分别为414.6±55.2、205.9±31.8、79.1±9.5U/L)明显低于对照组(分别为741.5±100.1、552.8±65.2、215.7±31.5U/L)(P<0.05);发生持续性异位妊娠、恶心呕吐、肝、肾功能损害明显少于对照组(P<0.05);社会功能、情绪功能、精神健康等生活质量评分(分别为74.2±10.8、68.4±8.1、66.0±9.2)明显高于对照组(分别为63.8±8.6、57.9±7.5、56.6±8.6)(P<0.05)。结论腹腔镜下甲氨蝶呤局部注射能够彻底杀灭滋养层细胞、预防持续性异位妊娠的发生,同时减少肝肾功能损害,并提高了生活质量,是输卵管妊娠保守手术的理想辅助治疗措施。
Objective:To observe the effect of topical use and muscle injection of methotrexate in patients with tubal pregnancy after laparoscopic conservative surgery.Methods:The patients with unruptured tubal pregnancy who received laparoscopic surgery in our hospital from March 2011 to December 2013 were enrolled and divided into observation group(topical use of methotrexate)and control group(intramuscular injection of methotrexate).Then serumβ-HCG levels,complications rate and quality of life were compared between the two groups.Results:The serumβ-HCG levels at 3,5and 7days after surgery in the patients of observation group(414.6±55.2,205.9±31.8,79.1±9.5U/L)were significantly lower than those in control group(741.5±100.1,552.8±65.2,215.7±31.5 U/L)(P<0.05).The incidences of persistent ectopic pregnancy,nausea and vomiting,renal or liver function damage were significantly lower than those in control group(P<0.05).The scores of life quality in social function,emotional function,mental health were significantly higher than those in control group(74.2±10.8vs.63.8±8.6,68.4±8.1vs.57.9±7.5,66.0±9.2vs.56.6±8.6,respectively)(P<0.05).Conclusions:Topical use of methotrexate by laparoscope is an ideal method in treatment of unruptured tubal pregnancy,which can thoroughly eliminate the trophoblast cells,prevent persistent ectopic pregnancy,reduce target organ damage,and improve the quality of life.
Objective:To observe the effect of topical use and muscle injection of methotrexate in patients with tubal pregnancy after laparoscopic conservative surgery.Methods:The patients with unruptured tubal pregnancy who received laparoscopic surgery in our hospital from March 2011 to December 2013 were enrolled and divided into observation group(topical use of methotrexate)and control group(intramuscular injection of methotrexate).Then serumβ-HCG levels,complications rate and quality of life were compared between the two groups.Results:The serumβ-HCG levels at 3,5and 7days after surgery in the patients of observation group(414.6±55.2,205.9±31.8,79.1±9.5U/L)were significantly lower than those in control group(741.5±100.1,552.8±65.2,215.7±31.5 U/L)(P<0.05).The incidences of persistent ectopic pregnancy,nausea and vomiting,renal or liver function damage were significantly lower than those in control group(P<0.05).The scores of life quality in social function,emotional function,mental health were significantly higher than those in control group(74.2±10.8vs.63.8±8.6,68.4±8.1vs.57.9±7.5,66.0±9.2vs.56.6±8.6,respectively)(P<0.05).Conclusions:Topical use of methotrexate by laparoscope is an ideal method in treatment of unruptured tubal pregnancy,which can thoroughly eliminate the trophoblast cells,prevent persistent ectopic pregnancy,reduce target organ damage,and improve the quality of life.
引文
[1]Al Sayed I.Assessment ofβ-human chorionic gonadotropin level as a reliable predictor of tubal patency confirmed with transvaginal ultrasound-guided selective salpingography(TVSSG)following conservative treatment of tubal pregnancy[J].Arch Gynecol Obstet,2012,285:1043-1048.
[2]苏碧英.宫外孕行腹腔镜下输卵管开窗取胚术局部注射甲氨蝶呤治疗的疗效分析[J].中国药物经济学,2013,2:216-217.
[3]许建营.异位妊娠[M].北京:中国医药科技出版社,2002:212-215.
[4]叶任高,刘冠贤.临床肾脏病学[M].第2版.北京:人民卫生出版社,1997:227-242.
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[6]彭世媚.异位妊娠的不同保守治疗方法的临床效果分析[J].当代医学,2011,17:95-96.
[7]欧丽红.高渗葡萄糖注入输卵管内预防异位妊娠保守性手术后持续性异位妊娠的临床研究[J].热带医学杂志,2013,13:336-338.
[8]阮军谊,梁燕.全身与局部应用甲氨蝶呤预防腹腔镜术后持续性异位妊娠的效果比较[J].广大医学院学报,2010,28:35-36.
[9]邓勍,古岭梅,周晓莉,等.输卵管妊娠腹腔镜保守术后持续性异位妊娠的临床观察[J].生殖医学杂志,2012,21:392-394.
[10]杨芳,刘小乐,韦瑞红,等.腹腔镜术中局部注射甲氨蝶呤对持续性异位妊娠的预防效果[J].检验医学与临床,2013,10:3248.
[11]Gong W,Li X,Ren H,et al.Superselective uterine arterial embolization combined with transcatheter intra-arterial methotrexate infusion in 40cases with fallopian tube ectopic pregnancy[J].Clin Exp Obstet Gynecol,2013,40:222-226.
[12]Sagiv R,Debby A,Feit H,et al.The optimal cutoff serum level of human chorionic gonadotropin for efficacy of methotrexate treatment in women with extrauterine pregnancy[J].Int J Gynaecol Obstet,2012,116:101-104.
[13]贾西伟.甲氨蝶呤借助腹腔镜靶组织给药治疗输卵管妊娠38例疗效观察[J].河南外科学杂志,2012,18:121.
[14]王丽娜,刘腊梅.宫腔镜下输卵管插管注射甲氨蝶呤治疗输卵管妊娠的临床研究[J].中国妇幼保健,2014,29:283-285.
[2]苏碧英.宫外孕行腹腔镜下输卵管开窗取胚术局部注射甲氨蝶呤治疗的疗效分析[J].中国药物经济学,2013,2:216-217.
[3]许建营.异位妊娠[M].北京:中国医药科技出版社,2002:212-215.
[4]叶任高,刘冠贤.临床肾脏病学[M].第2版.北京:人民卫生出版社,1997:227-242.
[5]Ware JE,Snow KK,Kosinski M,et al.SF-36 Health Survey Manual and Interpretation Guide[S].Boston,MA:The Health Institute,1993,1-12.
[6]彭世媚.异位妊娠的不同保守治疗方法的临床效果分析[J].当代医学,2011,17:95-96.
[7]欧丽红.高渗葡萄糖注入输卵管内预防异位妊娠保守性手术后持续性异位妊娠的临床研究[J].热带医学杂志,2013,13:336-338.
[8]阮军谊,梁燕.全身与局部应用甲氨蝶呤预防腹腔镜术后持续性异位妊娠的效果比较[J].广大医学院学报,2010,28:35-36.
[9]邓勍,古岭梅,周晓莉,等.输卵管妊娠腹腔镜保守术后持续性异位妊娠的临床观察[J].生殖医学杂志,2012,21:392-394.
[10]杨芳,刘小乐,韦瑞红,等.腹腔镜术中局部注射甲氨蝶呤对持续性异位妊娠的预防效果[J].检验医学与临床,2013,10:3248.
[11]Gong W,Li X,Ren H,et al.Superselective uterine arterial embolization combined with transcatheter intra-arterial methotrexate infusion in 40cases with fallopian tube ectopic pregnancy[J].Clin Exp Obstet Gynecol,2013,40:222-226.
[12]Sagiv R,Debby A,Feit H,et al.The optimal cutoff serum level of human chorionic gonadotropin for efficacy of methotrexate treatment in women with extrauterine pregnancy[J].Int J Gynaecol Obstet,2012,116:101-104.
[13]贾西伟.甲氨蝶呤借助腹腔镜靶组织给药治疗输卵管妊娠38例疗效观察[J].河南外科学杂志,2012,18:121.
[14]王丽娜,刘腊梅.宫腔镜下输卵管插管注射甲氨蝶呤治疗输卵管妊娠的临床研究[J].中国妇幼保健,2014,29:283-285.