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目的探讨甲氨蝶呤(MTX)用药途径及剂量对预防输卵管妊娠保守性手术后持续性异位妊娠(PEP)发生的效果,为临床提供实用的方案。方法将保守性手术治疗后的168例输卵管妊娠患者随机分成两组,A组(88例)术中给予MTX 20 mg患侧输卵管系膜内注射;B组(80例)MTX 50 mg术中肌内注射。所有患者均于术后1、4、7、11、14 d测定血β-HCG,观察其下降情况及PEP的发生率、用药物后的毒副作用。结果术后24 h血β-HCG值均较术前明显下降(>50%),但两组间差异无显著性;术后4 d两组间无明显差异,术后7、11天两组间差异显著(P<0.01),A组所有患者于术后11 d血β-HCG值均转阴(<25 IU/L),而B组在术后14 d才转阴。A组无1例发生PEP,B组发生2例(2.5%),差异无显著性(P>0.05)。B组中有15%(12/80)的患者出现了用药后的毒副反应。结论MTX 20 mg术中注入患侧输卵管系膜内是预防持续性异位妊娠的实用、高效方案。
Objective To investigate the effect of methotrexate (MTX) route and dose on the prevention of persistent ectopic pregnancy (PEP) after conservative surgery of tubal pregnancy, and to provide a practical solution for clinical practice. Methods 168 cases of tubal pregnancy after conservative surgery were randomly divided into two groups. Group A (88 cases) received MTX 20 mg ipsilateral tubal intraperitoneal injection intraperitoneally. Group B (80 cases) MTX 50 mg intraoperative Internal injection. All patients were measured blood β-HCG at 1,4,7,11,14 d after the observation of its decline and the incidence of PEP, with the drug side effects. Results The blood β-HCG value at 24 h after operation was significantly lower than that before operation (> 50%), but there was no significant difference between the two groups. There was no significant difference between the two groups on the 4th postoperative day. (P <0.01). The blood β-HCG values of all patients in group A turned negative (<25 IU / L) on the 11th day after operation, while those in group B turned negative on the 14th day after operation. There was no case of PEP in group A and 2 cases (2.5%) in group B, with no significant difference (P> 0.05). Fifteen percent (12/80) of patients in group B developed toxic side effects. Conclusion MTX 20 mg intraoperative injection into the ipsilateral tubal mesilar membrane is a practical and effective prevention of persistent ectopic pregnancy.