【摘要】 目的:探讨经阴道注水腹腔镜(THL)下甲氨蝶呤(MTX)注射对输卵管妊娠保守治疗的可行性、临床效果和安全性。方法:选择25例要求保守治疗的输卵管妊娠患者实行THL下输卵管注射MTX治疗(研究组),记录阴道后穹隆穿刺成功率、手术时间、保守治疗失败率,与单次肌内注射MTX组23例(对照组)比较术后7天血β-HCG下降率、住院时间、治疗失败率。观察研究组术后并发症。结果:研究组22例穿刺成功,穿刺成功率88.00%(22/25),3例严重盆腔粘连和1例术中出血患者,转行经腹腹腔镜手术,手术失败率16.00%(4/25),平均手术时间为25.54±2.50分钟。研究组术后7天血β-HCG平均下降率为(52.90%),与对照组(33.61%)比较,差异有统计学意义(P<0.05);两组平均住院时间分别为11.91±3.53天、16.00±6.40天,差异有统计学意义(P<0.05);治疗失败率分别为16.00%(4/25)、17.39%(4/23),两组比较差异无统计学意义(P>0.05)。21例THL下MTX输卵管注射患者术中无直肠损伤,无术后穿刺部位出血、盆腔感染等并发症发生。结论:THL下MTX输卵管注射治疗输卵管妊娠是安全、可行、有效的方法。更多还原

【Abstract】 Objective:To explore the feasibility,the clinical effect and the safety of expectant treatment for tubal pregnancy through transvaginal hydrolaparoscopy (THL) in association with Methotrexate (MTX) injection.Methods:25 patients with tubal pregnancy who ask for expectant treatment were treated through transvaginal hydrolaparoscopy in association with Methotrexate injection (study group).The successful rate of culdocentesis,operation time,the failure rate of expectant treatment and complications were recorded.The decrease rate of β-HCG 7 days after operation,hospitalization time,and the failure rate of treatment werecompared study group with Methotrexate single intramuscular injection group (control group).Results:Among those 25 tubal pregnancy cases,22 cases in study group had successful puncture,with 88.00% successful rate (22/25).3 patients with severe pelvic adhesions and 1 patient with hemorrhage during operation had been converted to transabdominal laparoscopy,ie.16.00% conversion rate(4/25).The average operation time was 25.54±2.50 mins.Compared with the control group (33.61%),the average decrease rate of β-HCG in study group was 52.90%.There was significant difference between them (P<0.05).The average hospitalization time for each group was 11.91±3.53 days and 16.00±6.40 days separately.There was significant difference between them (P<0.05).The failure rate of treatment in study group was 16.00%(4/25)compared with 17.39%(4/23)in control group.There was no significant difference between them (P>0.05).Meanwhile,there were no complications had been found in 21 patients treated by THL and MTX,such as rectum injure,insertion site bleeding,pelvic infection and so on.Conclusions:Treatment of tubal pregnancy by THL in association with MTX injection is safe,feasible and effective.更多还原