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目的:探讨甲氨蝶呤(MTX)联合腹腔镜手术治疗宫外孕的有效剂量,为治疗宫外孕提供参考。方法:将165例宫外孕患者随机分为低剂量组(n=56,采用MTX 25 mg联合腹腔镜治疗)、中剂量组(n=59,采用MTX 50 mg联合腹腔镜治疗)、高剂量组(n=50,采用MTX 100 mg联合腹腔镜治疗),比较3组术前与术后3、7、14 d的血β-HCG水平及恢复正常的时间,随访2年内宫内妊娠率及持续异位妊娠(PEP)的发生率。结果:中剂量组术后3、7、14 d血β-HCG水平明显低于低剂量组,且恢复正常的时间明显缩短;高剂量组术后3、7、14 d血β-HCG水平明显低于低剂量组和中剂量组,且恢复正常的时间较其他两组也明显缩短。3组术后随访2年,PEP及术后1年宫内妊娠率差异无统计学意义(均P>0.05);高剂量组、中剂量组术后2年宫内妊娠率明显高于低剂量组(均P<0.05)。3组不良反应发生率比较差异有统计学意义(P<0.05),且高剂量组明显高于中剂量组和低剂量组,但中剂量组与低剂量组间差异不明显(P>0.05)。结论:腹腔镜手术联合中等剂量MTX治疗宫外孕能更有效地提高临床疗效,安全性较好。
Objective: To investigate the effective dose of methotrexate (MTX) combined with laparoscopic surgery in the treatment of ectopic pregnancy and provide reference for the treatment of ectopic pregnancy. Methods: 165 cases of ectopic pregnancy were randomly divided into low dose group (n = 56, MTX 25 mg combined with laparoscopy), middle dose group (n = 59, MTX 50 mg combined with laparoscopy), high dose group n = 50 and MTX 100 mg combined with laparoscopy). The levels of β-HCG and the time to return to normal before and 3, 7 and 14 days after operation were compared between the two groups. The intrauterine pregnancy rate Pregnancy (PEP) incidence. Results: The levels of β-HCG in the middle-dose group were significantly lower than those in the low-dose group at 3, 7 and 14 days after operation, and the recovery time was significantly shortened. The levels of β-HCG in the high-dose group were significantly higher at 3, 7 and 14 days Lower than the low-dose group and middle-dose group, and the time to return to normal than the other two groups also significantly shortened. There was no significant difference in intrauterine pregnancy rate between PEP group and 1 year after operation (all P> 0.05). The intrauterine pregnancy rate of 2 groups in high dose group and middle dose group was significantly higher than that in low dose group Group (all P <0.05). The incidence of adverse reactions in the three groups was significantly different (P <0.05), and the high dose group was significantly higher than the middle dose group and the low dose group, but there was no significant difference between the middle dose group and the low dose group (P> 0.05) . Conclusion: Laparoscopic surgery combined with MTX in the treatment of ectopic pregnancy can be more effective in improving clinical efficacy, safety is better.