【摘要】 目的　探讨甲氨喋呤肌肉注射治疗异位妊娠的最佳适应证和安全性。方法　对诊断为未破裂的异位妊娠患者 ,以甲氨喋呤 5 0mg/m2 肌注 ,少数患者在首次注射后重复一次。结果　在 10 9例患者中 ,10 0例保守治疗成功 ,总的成功率为 91 7%。其中 ,血 β -hCG浓度小于 2 5nmol/L (正常值 <0 82nmol/L)的患者 ,成功率达 97 7% ,而血浆 β -hCG浓度大于 2 5nmol/L的患者 ,成功率仅 66 7%。在保守治疗成功的患者中 ,前者的二次注射率为 2 3 % ,而后者的二次注射率则高达 5 0 0 %。保守治疗成功率和二次注射率在两组患者中的差别均有极显著意义 (P <0 0 0 1)。结论　对于早期异位妊娠 ,大剂量甲氨喋呤肌肉注射治疗是有效的 ,尤其是注射药物前血浆 β -hCG浓度小于 2 5nmol/L的患者 ,疗效是肯定的。但是 ,对于血浆 β -hCG浓度大于 2 5nmol/L的患者 ,或者有癌症家族史患者 ,或者有癌症易感倾向的患者 ,应该尽量不考虑使用甲氨喋呤治疗。更多还原

【Abstract】 Objective To explore the optimal indication and safety of managing ectopic pregnancy by intramuscular injection of high dose of methotrexate.Methods The patient with unruptured ectopic pregnancy was injected with 50mg/m 2 of methotrexate, the injection of methotrexate was repeated at the same dose if the level of the β-subunit of human chorionic gonadotropin continues to rise or maintain at a high level 7 days after the primary injection.Results Of 109 cases,100 the patients with ectopic pregnancy were succeeded by conservative therapy. The total success rate was 91 7%. The success rate was 97 7% in patients with a level of the β-subunit of human chorionic gonadotropin less than 2 5 nmol/L (the normal value is less than 0 82nmol/L), whereas it was 66 7% in patients with a level of the β-subunit of human chorionic gonadotropin greater than 2 5nmol/L, the difference was statistically significant (P<0 001). And 2 3% of cases in the former group needed a repeated injection at the same dose, and there was as high as 50% of patients in the latter group received repeated injection. The difference between two groups was significant as well (P<0 001). In addition, 2 cases of patients with a mild neutropenia were discovered, and 1 case of ovarian carcinoma was one and half year followed by the medicament therapy of the ectopic pregnancy.There were 2 patients in intraperitoneal bleeding after discharge from the hospital.Conclusions It is effective in managing patients with ectopic pregnancy by using high dosage intramuscular injection of methotrexate at the early stage. In especial the patients with a level of β-subunit of human chorionic gonadotropin less than 2 5nmol/L is optimal therapy.It should not consider the chemotherapeutic management in patients with a β-subunit of human chorionic gonadotropin greater than 2 5nmol/L,with a familial history of cancer, and with a disposition to malignant status.更多还原