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目的:探讨甲氨蝶呤(MTX)预防腹腔镜下输卵管切开取胚术后持续性异位妊娠(PEP)的疗效。方法:选择60例未破裂型异位妊娠患者,分别采用腹腔镜下输卵管切开取胚术联合MTX保守手术治疗(观察组,32例)和单纯腹腔镜下输卵管切开取胚术治疗(对照组,28例)。观察两组患者血β-HCG恢复正常时间、术后住院时间和PEP发生率。治疗后随访3个月行子宫输卵管造影术,观察输卵管再通率。结果:两组患者均顺利完成手术。观察组血β-HCG恢复正常时间[(10.05±2.54)d]和术后住院时间[(10.54±3.02)d]明显短于对照组[(12.17±3.47)d和(12.84±3.87)d](P<0.05),观察组PEP发生率(0%)明显低于对照组(17.86%)(P<0.05),治疗后随访3个月观察组输卵管再通率(93.75%)也明显高于对照组(71.43%)(P<0.05)。结论:术中预防性局部注射MTX预防腹腔镜下输卵管切开取胚术后PEP的疗效肯定,术中注意操作技巧可提高疗效,减少腹腔异位妊娠种植。
Objective: To investigate the efficacy of methotrexate (MTX) in preventing persistent ectopic pregnancy (PEP) after laparoscopic tubal embryooplasty. Methods: Sixty patients with unruptured ectopic pregnancy were enrolled in this study. Laparoscopic tubal excision combined with conservative surgery of MTX (observation group, 32 cases) and simple laparoscopic tubal excision and embryo implantation (control group Group, 28 cases). Observe the blood β-HCG recovery time, postoperative hospital stay and PEP incidence in both groups. Follow-up 3 months after treatment, hysterosalpingography, observation of tubal recanalization rate. Results: The two groups of patients successfully completed the operation. The mean time to recovery of β-HCG in the observation group was shorter than that in the control group [(10.05 ± 2.54) d] and postoperative hospital stay (10.54 ± 3.02 days) [(12.17 ± 3.47) days and (12.84 ± 3.87 days) (P <0.05). The incidence of PEP (0%) in the observation group was significantly lower than that in the control group (17.86%) (P <0.05). The follow-up 3 months after the treatment also showed a significantly higher rate of tubal recanalization (93.75% Control group (71.43%) (P <0.05). CONCLUSION: Intraoperative prophylactic local injection of MTX is effective in preventing PEP after laparoscopic tubal embryooplasty. Attention should be paid to the operation technique to improve the curative effect and reduce the implantation of intraperitoneal ectopic pregnancy.