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目的通过监测输卵管妊娠保留输卵管手术后48 h内血清孕酮(P)和绒毛膜促性腺激素(β-h CG)水平,分析两种激素下降趋势,为临床预测治疗效果提供参考。方法回顾性分析2012年6月-2014年11月160例输卵管妊娠患者的临床资料,并按手术方式分组,A组行输卵管切除术,B组行输卵管开窗病灶清除术,两组治疗前均测定血清P和β-h CG水平,术后18 h及42 h各测1次血清P和β-h CG值,此后门诊监测随访至血清P和β-h CG降到正常值。结果 1两组术后P及β-h CG均明显下降,两组术后18 h及42 h P及β-h CG下降水平无统计学差异(P>0.05);2两组术后18 h及42 h测定P及β-h CG与术前比较下降幅度基本相同(P>0.05);3两组P及β-h CG降至正常时间基本相同(P>0.05);4两组P降至正常时间均快于β-h CG(P<0.05);5两组均无持续性宫外孕病例。结论 1输卵管妊娠保留输卵管治疗与切除输卵管治疗血清P和β-h CG均迅速下降,良好满意的病灶清除术与输卵管妊娠病灶切除术血清P和β-h CG的下降趋势及幅度基本相同,两种术式均可达到理想的治疗效果。2血清P和β-h CG的联合监测,可作为输卵管妊娠保守治疗效果的近期监测指标,术后42 h下降大于70%或在73.04%~81.88%范围,可排除持续性宫外孕可能。3P在术后降至正常范围的时间早于β-h CG,1周后P已降至正常而失去监测意义,血清β-h CG更适合于治疗1周以后的远期效果监测。
Objective To monitor the level of serum progesterone (P) and chorionic gonadotropin (β-h CG) within 48 h after tubal surgery, and to analyze the downward trend of the two hormones in order to provide a reference for the clinical prediction of the therapeutic effect. Methods The clinical data of 160 patients with tubal pregnancy from June 2012 to November 2014 were analyzed retrospectively. The patients underwent tubal resection in group A and the oviduct window clearing in group B. Serum P and β-h CG levels were measured. Plasma P and β-h CG values were measured at 18 h and 42 h after surgery, respectively. Outpatients were followed up until the serum P and β-h CG were normalized. Results 1 Both P and β-h CG were significantly decreased in both groups. There was no significant difference in P and β-h CG between the two groups at 18 h and 42 h (P> 0.05) (P> 0.05); P and β-h CG in 42 h were basically the same (P> 0.05) compared with those before operation; P and β-h CG in both groups were basically the same To normal time were faster than β-hCG (P <0.05); 5 cases of no persistent ectopic pregnancy in both groups. Conclusions 1 tubal pregnancy with tubal retention and removal of tubal treatment serum P and β-h CG were rapidly decreased, good and satisfactory removal of the disease and tubal pregnancy resection serum P and β-h CG downward trend and amplitude are basically the same, two Surgery can achieve the desired effect of treatment. 2 serum P and β-h CG combined monitoring, tubal pregnancy can be used as a conservative treatment of recent monitoring indicators, 42 h after the decline of more than 70% or in the range of 73.04% to 81.88%, can rule out the possibility of persistent ectopic pregnancy. 3P in the postoperative drop to the normal range of time as early as β-hCG, 1 week after the P has dropped to normal and lose the meaning of monitoring, serum β-hCG is more suitable for the treatment of 1 week after the long-term effect monitoring.