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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。
Objective To investigate the curative effect of three kinds of conservative treatment of tubal pregnancy (TP) and its clinical value. Methods 274 patients who were diagnosed as TP in our hospital from October 2005 to August 2010 were enrolled in this study. The patients were randomly divided into 3 groups according to the order of treatment, and received 3 kinds of treatment respectively: intervention group (n = 94), MTX group (n = 89) and 5-Fu (fluorouracil group) 91). Three kinds of conservative treatment were compared efficacy, incidence of adverse reactions, hospitalization costs and time. Tubal lipiodol angiography (HSG) was performed six months after the end of treatment to understand the degree of tubal patency and childbirth (The procedure followed in this study was in line with the ethical standards set by the human body testing committee of our hospital and was approved by the committee , The subjects obtained the informed consent of the group, and signed with the informed consent of clinical research). There were no significant differences in age, menopause time, serum β-human chorionic gonadotropin (hCG) level, vaginal bleeding time and gestational sac diameter between the three groups (P> 0.05). Results The success rate (100.00%, 94/94) in intervention group was significantly higher than that in MTX group (75.28%, 67/89) and 5-Fu group (79.12%, 72/91) (P <0.01). Patients in each group were asked to retain reproductive function after six months of treatment, tubal HSG ipsilateral, tubal patency rate (obstruction rate) were compared between the three groups, the difference was not statistically significant (P> 0.05), but the interventional treatment of reproductive function (P <0.01). The difference of fertility between the three groups was statistically significant (P <0.01). Conclusion The three kinds of conservative treatment have some effect on the treatment of TP. Among them, interventional therapy has the best curative effect, but requires higher equipment and technology, and the cost is also high, making it difficult to promote in primary hospitals. Therefore, MTX intramuscular injection and 5-Fu intravenous infusion of TP, is still a good way to treat primary TP hospital.