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目的 探讨介入治疗输卵管妊娠的临床价值和治疗途径。方法 分析 2种介入途径治疗的 18例输卵管妊娠患者 ,其中 8例为经阴道输卵管插管孕囊内注射氨甲喋呤 (MTX) ,10例为经子宫动脉插管灌注MTX +栓塞 ,选用Cook公司双球囊输卵管再通装置和 4.1FrCobra导管。术后以患者症状、体征、β HCG水平及孕囊的B超值的动态变化作为疗效的监测指标。 结果 18例总插管成功率、治愈率、杀胚率分别为 10 0 %、88.9% (16 / 18)、94.4% (17/ 18) ,2例经阴道途径治疗失败。尿 β HCG下降至正常 (3～ 2 8d)平均 (11.2± 11.6 )d ,B超示孕囊在治疗后 2～ 3周内消失 10例 ,占 76 .9% (10 / 13) ,最长 6 0d消失 ,恢复正常月经平均 (37± 9)d(2 1～ 5 0d)。结论 介入治疗输卵管妊娠疗效可靠 ,操作简便 ,尤其经动脉途径更有价值 ,介入治疗应成为终止输卵管妊娠的重要手段。
Objective To investigate the clinical value and treatment of interventional tubal pregnancy. Methods 18 cases of tubal pregnancy treated by two kinds of interventional methods were analyzed. Among them, 8 cases were transvaginal tubal intubation and intraperitoneal injection of methotrexate (MTX), 10 cases were transcatheter uterine arterial infusion of MTX + embolization, Cook double Cystic tubal recanalization device and 4.1 FrCobra catheter. Postoperative patients with symptoms, signs, β HCG levels and gestational sac B value dynamic changes as indicators of efficacy. Results The success rate, cure rate and kill embryo rate of the total intubation in 18 cases were 100%, 88.9% (16/18) and 94.4% (17/18), respectively. Two cases failed the transvaginal approach. Urine β HCG decreased to normal (3 ~ 28 days) average (11.2 ± 11.6) d, B ultrasound showed gestational sac disappeared within 2 to 3 weeks after treatment in 10 cases, accounting for 76.9% (10/13), the longest 6d disappear, return to normal menstruation (37 ± 9) d (21 ~ 50d). Conclusion Interventional treatment of tubal pregnancy reliable, easy to operate, especially through the arterial route is more valuable, intervention should be an important means to terminate tubal pregnancy.