甲氨蝶呤联合米非司酮治疗异位妊娠后改善生殖功能的临床研究

Improvement of reproductive function of patients with ectopic pregnancy after treatment of methotrexate combined with mifepristone

摘要:

目的：探讨甲氨蝶呤联合米非司酮及大黄芒硝外敷治疗异位妊娠后对生殖功能的影响。方法：回顾性分析未破裂型输卵管妊娠、生命体征平稳、血清人绒毛膜促性腺激素＜2 000 IU/L、年龄＜35岁、临床资料完整且有生育要求的202例患者，根据患者意愿选择药物保守治疗的为研究组95例，腹腔镜保守手术的为对照组107例，分2组分别随访治疗后1.5~4.0年的生殖状态及并发症发生情况。结果：研究组与对照组宫内妊娠率及继发不孕率，分别为37.9%、62.1%与37.4%、62.6%，其中各组活产率分别为61.1%、62.5%，两组比较差异无统计学意义（P ＞0.05）；而重复异位妊娠率研究组（5.3%）明显低于对照组（22.4%），差异有统计学意义（P＜0.01）。结论：3种药物保守治疗后的生殖结局与腹腔镜保守手术相近，同时还可降低并发症风险。因此是一种治疗安全、有效、价廉的好方法，也可获得满意的远期生殖状态。

Abstract:

Objective：To investigate the effects of methotrexate（MTX） combined with mifepristone and rhubarb mirabilite on reproduc－tive function after ectopic pregnancy. Methods：Totally 202 patients with unruptured tubal pregnancy，stable vital signs，blood human chorionic gonadotropin（HCG） under 2 000 IU/ L，age under 35 years，integrity clinical data and requirements for fertility were enrolled. They were divided into two groups according to their wishes；95 patients in study group chose conservative medical treatment and 107 patients in control group chose laparoscopic surgery and reserved fallopian tubes. Reproductive status and occurrence of complications were followed up for 1.5 to 4.0 years after the treatment. Results：Rates of pregnancy and infertility were 37.9% and 62.1% in study group and 37.4% and 62.6% in control group. Rates of live birth in study group and control group were 61.1% and 62.5% respec－tively，without statistically significant differences（P >0.05）. Rate of recurrent ectopic pregnancy in study group（5.3%） was significant－ly lower than that in control group（22.4%），with statistically significant differences（P<0.01）. Conclusions：Conservative medical treat－ment can achieve similar reproductive outcome as laparoscopic surgery and can reduce incidences of recurrent ectopic pregnancy.Therefore，conservative medical treatment is a safe，effective and inexpensive method and can achieve satisfactory long-term repro－ductive status.