CAJ | 학술논문

目的：观察甲氨蝶呤(MTX)经阴道注水腹腔镜(THL)治疗输卵管妊娠的临床效果。方法本院2010年7月~2013年10月收治的82例输卵管妊娠患者根据随机数字表法分为两组，对照组(n=40)采用肌内注射MTX治疗，观察组(n=42)采用MTX THL治疗。记录观察组手术情况，比较两组治愈率、血清β-HCG水平下降至正常范围时间、不良反应发生率、住院天数、住院费用、1周后妊娠包块大小、输卵管再通率。结果 THL平均手术操作时间为(26.1±4.4) min，后穹隆穿刺成功率100%，与术前输卵管妊娠诊断完全符合，术中未发生并发症，术中发现有4例对侧输卵管阻塞现象。观察组治愈率明显高于对照组(P<0.05)，不良反应发生率低于对照组(P<0.05)，住院天数明显短于对照组(P<0.05)；两组住院费用比较差异无统计学意义(P>0.05)；观察组血β-HCG下降至正常时间明显快于对照组(P<0.05)，1周后妊娠包块大小明显小于对照组(P<0.05)，输卵管再通率明显高于对照组(P<0.05)。结论 THL下MTX注射治疗输卵管妊娠安全有效，值得临床推广应用。
목적：관찰갑안접령(MTX)경음도주수복강경(THL)치료수란관임신적림상효과。방법본원2010년7월~2013년10월수치적82례수란관임신환자근거수궤수자표법분위량조，대조조(n=40)채용기내주사MTX치료，관찰조(n=42)채용MTX THL치료。기록관찰조수술정황，비교량조치유솔、혈청β-HCG수평하강지정상범위시간、불량반응발생솔、주원천수、주원비용、1주후임신포괴대소、수란관재통솔。결과 THL평균수술조작시간위(26.1±4.4) min，후궁륭천자성공솔100%，여술전수란관임신진단완전부합，술중미발생병발증，술중발현유4례대측수란관조새현상。관찰조치유솔명현고우대조조(P<0.05)，불량반응발생솔저우대조조(P<0.05)，주원천수명현단우대조조(P<0.05)；량조주원비용비교차이무통계학의의(P>0.05)；관찰조혈β-HCG하강지정상시간명현쾌우대조조(P<0.05)，1주후임신포괴대소명현소우대조조(P<0.05)，수란관재통솔명현고우대조조(P<0.05)。결론 THL하MTX주사치료수란관임신안전유효，치득림상추엄응용。
Objective To observe the clinical effect of methotrexate (MTX)transvaginal hydrolaparoscopy (THL)in the treatment of tubal pregnancy. Methods 82 patients of tubal pregnancy in our hospital from July 2010 to October 2013 were randomly divided into two groups according to the digital meter method,MTX by intramuscular injection was used in control group(n=40),and MTX by THL was applied in observation group(n=42).The operation situation in observation group was recorded.The cure rate,the time of serum β-HCG decreased to normal range,the incidence rate of adverse reaction,hospitalization day and hospitalization expense,the size of pregnancy mass 1 week after treatment,rate of fallopi-an tube between two groups were compared. Results The average time of THL operation was(26.1±4.4) min,the success rate of puncture in posterior fornix was 100%,certainly in preoperative diagnosis of tubal pregnancy,and had no compli-cation in treatment,4 cases of the contralateral fallopian tube obstruction phenomena were found in treatment.The cure rate of observation group was significantly higher than that of control group (P<0.05),the incidence rate of adverse reac-tion in observation group was lower than that in control group (P<0.05),hospitalization day of observation group was sig-nificantly shorter than that of control group(P<0.05).There was no statistical difference about hospitalization expense be-tween two groups (P>0.05).The time of serum β-HCG decreased to normal range in observation group was significantly faster than that in control group(P<0.05),the mass size after 1 week of pregnancy in observation group was less than that in control group (P<0.05),the rate of fallopian tube in observation group was significantly higher than that in control group (P<0.05). Conclusion MTX under THL in the treatment of tubal pregnancy is safe and effective,it is worthy of clinical popularization and application.