CAJ | 학술논문

目的探讨3种保守方法治疗输卵管妊娠(TP)的疗效及其在临床中的应用价值.方法选择2005年10月至2010年8月在本院就诊并确诊为TP的274例患者为研究对象.将其按就诊顺序随机分为3组,分别接受3种方式治疗:介入组(n=94),MTX(甲氨蝶呤)组(n=89)及5-Fu(氟尿嘧啶)组(n=91).分别比较3种保守治疗方式的疗效、不良反应发生率、住院费用和时间等.对有生育要求者分别于治疗结束半年后行输卵管碘油造影(HSG),了解输卵管通畅度及生育情况(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试者的知情同意,并与其签署临床研究知情同意书).3组患者的年龄、停经时间、治疗前血清β-人绒毛膜促性腺激素(hCG)水平、阴道流血时间和孕囊直径比较,差异无统计学意义(P＞0.05).结果介入组治疗成功率(100.00％,94/94)明显高于MTX组(75.28％,67/89)及5 Fu组(79.12％,72/91),组间比较,差异有统计学意义(P＜0.01).各组治疗后要求保留生育功能的患者,于治疗结束半年后进行患侧输卵管HSG,3组输卵管通畅率(阻塞率)比较,差异无统计学意义(P＞0.05),但介入治疗对生育功能的影响最小,3组患者生育功能比较,差异有统计学意义(P＜0.01).结论 3种保守治疗方法对TP的治疗均有一定效果.其中,介入治疗的疗效最好,但对设备及技术要求更高,费用亦高,在基层医院难于推广.故MTX肌内注射及5-Fu静脉滴注治疗TP,仍是基层医院治疗TP的较好方法.
목적 탐토3충보수방법치료수란관임신(TP)적료효급기재림상중적응용개치.방법 선택2005년10월지2010년8월재본원취진병학진위TP적274례환자위연구대상.장기안취진순서수궤분위3조,분별접수3충방식치료:개입조(n=94),MTX(갑안접령)조(n=89)급5-Fu(불뇨밀정)조(n=91).분별비교3충보수치료방식적료효、불량반응발생솔、주원비용화시간등.대유생육요구자분별우치료결속반년후행수란관전유조영(HSG),료해수란관통창도급생육정황(본연구준순적정서부합본원인체시험위원회소제정적윤리학표준,득도해위원회비준,분조정득수시자적지정동의,병여기첨서림상연구지정동의서).3조환자적년령、정경시간、치료전혈청β-인융모막촉성선격소(hCG)수평、음도류혈시간화잉낭직경비교,차이무통계학의의(P＞0.05).결과 개입조치료성공솔(100.00％,94/94)명현고우MTX조(75.28％,67/89)급5 Fu조(79.12％,72/91),조간비교,차이유통계학의의(P＜0.01).각조치료후요구보류생육공능적환자,우치료결속반년후진행환측수란관HSG,3조수란관통창솔(조새솔)비교,차이무통계학의의(P＞0.05),단개입치료대생육공능적영향최소,3조환자생육공능비교,차이유통계학의의(P＜0.01).결론 3충보수치료방법대TP적치료균유일정효과.기중,개입치료적료효최호,단대설비급기술요구경고,비용역고,재기층의원난우추엄.고MTX기내주사급5-Fu정맥적주치료TP,잉시기층의원치료TP적교호방법.
Objective To explore three kinds of conservative methods to treat tubal pregnancy (TP)and its application value in clinical effects.Methods A total of 274 patients who were diagnosed as TP from October 2005 to August 2010 in our hospital were included into this study.They were divided into three groups randomly and received three kinds of treatment methods,intervention group (n =94),MTX (methotrexate) group (n=89) and 5-Fu (fluorouracil) group (n=91).The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Affiliated Hospital of North Sichuan Medical College.Informed consent was obtained from each patient.Curative effects,adverse effects,expenses and hospitalized time were compared among three groups.After half a year of the treatment,patients with fertility requirement underwent hysterosalpingogram(HSG) requirements at sixth month after operation,in order to find out oviduct tubes unobstructed degrees.There had no significant difference among three groups on patients' age,menopause time,serum β-hCG level before treatment,vaginal bleeding time and pregnant capsule diameter (P＞0.05).Results The successful rate in intervention group (100.00％,94/94) was significantly higher than that of MTX group (75.28％,67/89) and 5 Fu group (79.12％,72/91) (P＜0.01 ).There had no significant difference of tubal patency rate at sixth months after treatment among three groups (P＞0.05).But intervention treatment had the minimal impact on reproductive functions.There had significant difference of reproductive function among three groups (P＜0.01).Conclusions Three kinds of conservative treatment of TP have certain effects.Among them,the curative effect of interventional treatment is the best,but the equipment and technology requirements are higher,and the cost is also high.MTX (muscle injection) and 5-Fu (intravenous drip) are still better methods in the treatment of TP at the basic-level hospital.