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目的探讨治疗不同类型异位妊娠的适宜治疗方法。方法本院在2006年12月—2008年12月诊断异位妊娠并住院患者共207例,根据患者入院时的自觉症状,生命体征情况,血hCG结果,B超测量附件区包块大小分成四组。采用四种不同治疗方案即开腹手术、腔镜手术、注射MTX、口服米非司酮;衡量治疗方法的标准根据每种方法是否需要二次治疗、血hCG转阴天数以及住院天数。结果开腹手术35例(17%),腹腔镜手术112例(54%),注射MTX33例(16%),口服米非司酮27例(13%)。所有的开腹手术患者不需要进一步的随访。开腹手术和腔镜手术的147例之中的146例均痊愈,只有1例行腔镜下切开取胚术后因持续性宫外孕需要二次开腹手术,注射MTX的33例中有25例不再需要进一步的治疗,另外2例需二次注射MTX,另有6例(18%)因服药后自觉腹痛明显或者有内出血征象而行腹腔镜手术。口服米非司酮组27例,其中有4例(15%)因中途腹痛明显或者有内出血征象而行腹腔镜手术。剖腹手术、腔镜手术、注射MTX、口服米非司酮治疗住院天数分别为8.0、4.5、14.5、15d,血hCG转阴时间为7.5、7.2、14.5、12d。结论宫外孕患者中接近1/6的有剧烈腹痛病史的患者需要紧急手术,大约29%的患者可以用非手术方案治疗,根据病情选择适宜的治疗方案会取得良好的临床效果。
Objective To explore the appropriate treatment for different types of ectopic pregnancy. Methods The hospital in December 2006 -2008 in December diagnosis of ectopic pregnancy and in-patients were 207 cases, according to the patient’s symptoms at admission, vital signs, blood hCG results, B-measurement annex block size is divided into four group. Four different treatment regimens, laparotomy, endoscopic surgery, MTX injection, and oral mifepristone were used. The criteria for measuring treatment were based on whether each treatment required secondary treatment, the number of days of blood hCG overdose, and the number of days of hospitalization. Results 35 cases (17%) underwent laparotomy, 112 cases (54%) underwent laparoscopy, 33 cases received injection of MTX (16%) and 27 cases (13%) received oral mifepristone. All patients undergoing open surgery do not require further follow-up. Of the 147 cases of laparotomy and endoscopic surgery, 146 cases were cured. Only 1 case underwent endoscopic ectopic pregnancy required laparotomy for laparotomy. Of the 33 cases injected with MTX, 25 Cases no longer need further treatment, the other two cases required two injections of MTX, while the other 6 cases (18%) due to the obvious abdominal pain after taking medication or signs of internal bleeding and laparoscopic surgery. Oral mifepristone group, 27 cases, of which 4 cases (15%) due to abdominal pain or bleeding signs of laparoscopic surgery. Laparotomy, endoscopic surgery, MTX injection, oral mifepristone treatment days were 8.0,4.5,14.5,15 d, blood hCG negative time was 7.5,7.2,14.5,12 d. Conclusion Nearly one-sixth of patients with ectopic pregnancy who have a history of severe abdominal pain require urgent surgery, and about 29% of patients with ectopic pregnancy can be treated with a non-surgical regimen. Choosing the appropriate treatment according to the condition will produce good clinical outcomes.