腹腔镜下低β-hCG水平输卵管妊娠保守手术局部应用甲氨蝶呤的价值
|
摘要
目的探讨腹腔镜下低β-hCG水平的输卵管妊娠保守手术局部注射甲氨蝶呤(methotrexate,MTX)的应用价值。方法选取2015年7月至2017年12月昆明医科大学第一附属医院妇产科输卵管妊娠β-hCG<3 000 IU/L的患者81例,根据术中不同治疗方法分成实验组(腹腔镜下输卵管开窗取胚术+输卵管局部MTX注射)和对照组(腹腔镜下输卵管开窗取胚术)。比较2组术后β-hCG水平下降至正常的时间、术后持续输卵管妊娠的发生率、术后输卵管通畅情况、术后肝肾功能损伤情况。结果实验组术后β-hCG降至正常时间(19.0±10.8) d与对照组(14.8±8.8) d,P>0.05;术后第4天β-hCG水平变化比较,实验组(167.8±113.3) IU/L,对照组(135.6±90.8) IU/L,P>0.05;术后第7天β-hCG水平变化比较,实验组(37.1±35.1I)U/L,对照组(40.3±38.5) IU/L,P>0.05;术后第14天β-hCG水平变化比较,实验组(10.6±9.0I) U/L,对照组(14.7±13.1I) U/L,P>0.05;实验组术后持续输卵管妊娠的发生率(5.26%)与对照组(0%),P>0.05;术侧输卵管通畅情况,实验组(37.0%)与对照组(29.6%),P>0.05;实验组术后肝肾功能损伤1例高于对照组0例。结论β-hCG小于3 000 IU/L的输卵管妊娠腹腔镜保守手术中输卵管局部不使用MTX术并不增加持续性输卵管妊娠和术后输卵管阻塞的风险。
Objective To study the value of MTX injection in laparoscopic conservative treatment of fallopian tube pregnancy. Methods This study included 81 patients with tubal pregnancy and β-hCG<3 000 IU/L between July 2015 and December 2017. According to different intraoperative treatment methods, they were divided into experimental group(laparoscopic fallopian tube fenestration + local MTX injection of fallopian tube) and control group(laparoscopic fallopian tube fenestration). The two groups were compared in terms of the time when the postoperative β-CG level decreased to normal, the incidence of postoperative continuous tubal pregnancy,postoperative tubal patency, and postoperative liver and kidney function injury. Results The time it took for Serum β-hCG concentration being normal in the combination group was(19.0±10.8 d) and in the control group was(14.8 ±8.8 d),(P >0.05); Serum β-hCG concentration, measured on day 4, was(167.8 ±113.3 IU/L) in the combination group, and(135.6±90.8 IU/L) in the control group,(P>0.05); Serum β-hCG concentration, measured on day 7, was(37.1±35.1 IU/L) in the combination group, and was(40.3±38.5 IU/L) in the control group,(P>0.05);Serum β-hCG concentration, measured on day 14, was(10.6±9.0 IU/L) in the combination group, and was(14.7±13.1 IU/L) in the control group,(P>0.05); The rate of persistent ectopic pregnancy(PEP) in the combination group was 5.26% and was 0% in the control group(P>0.05); The rate of the operative side fallopian being unobstructed in the combination group was 37.0% and was29.6% in the control group(P>0.05);One patient was found with abnormal of hepatic and renal function in the combination group,but it wasn't found in the control group. Conclusion Laparoscopic conservative operation with β-hCG less than 3000 IU/L without use of MTX in the fallopian tube does not increase the risk of persistent tubal pregnancy(PEP) and postoperative fallopian tube obstruction.
Objective To study the value of MTX injection in laparoscopic conservative treatment of fallopian tube pregnancy. Methods This study included 81 patients with tubal pregnancy and β-hCG<3 000 IU/L between July 2015 and December 2017. According to different intraoperative treatment methods, they were divided into experimental group(laparoscopic fallopian tube fenestration + local MTX injection of fallopian tube) and control group(laparoscopic fallopian tube fenestration). The two groups were compared in terms of the time when the postoperative β-CG level decreased to normal, the incidence of postoperative continuous tubal pregnancy,postoperative tubal patency, and postoperative liver and kidney function injury. Results The time it took for Serum β-hCG concentration being normal in the combination group was(19.0±10.8 d) and in the control group was(14.8 ±8.8 d),(P >0.05); Serum β-hCG concentration, measured on day 4, was(167.8 ±113.3 IU/L) in the combination group, and(135.6±90.8 IU/L) in the control group,(P>0.05); Serum β-hCG concentration, measured on day 7, was(37.1±35.1 IU/L) in the combination group, and was(40.3±38.5 IU/L) in the control group,(P>0.05);Serum β-hCG concentration, measured on day 14, was(10.6±9.0 IU/L) in the combination group, and was(14.7±13.1 IU/L) in the control group,(P>0.05); The rate of persistent ectopic pregnancy(PEP) in the combination group was 5.26% and was 0% in the control group(P>0.05); The rate of the operative side fallopian being unobstructed in the combination group was 37.0% and was29.6% in the control group(P>0.05);One patient was found with abnormal of hepatic and renal function in the combination group,but it wasn't found in the control group. Conclusion Laparoscopic conservative operation with β-hCG less than 3000 IU/L without use of MTX in the fallopian tube does not increase the risk of persistent tubal pregnancy(PEP) and postoperative fallopian tube obstruction.
引文
[1]WYROBA J,KRZYSIEK J,RAJTAR-CIOSEK A,et al.,High live birth rate after conservative treatment of ectopic pregnancy with methotrexate[J].Ginekol.Pol.[J],2014,85(2):105-110.
[2]KIRK E,PAPAGEORGHIOU A T,CONDOUS G,et al.The diagnostic effectiveness of an initial transvaginal scan in detecting ectopic pregnancy[J].Hum Reprod,2007,22(11):2824-2828.
[3]曾玲,黄洪萍,苏莉,等.β-HCG水平与宫外孕保守治疗的临床探讨[J].实用妇科内分泌电子杂志,2015,2(9):1-2.
[4]许少榆.不同水平β-HCG的异位妊娠采用药物保守治疗与腹腔镜保守手术的疗效分析[J].齐齐哈尔医学院学报,2017,38(08):879-881.
[5]MORSE A,SI W,QIN S,et al.Optimal use of peri-operative human chorionic gonadotrophin concentrations to identify persistent ectopic pregnancy after laparoscopic salpingostomy:a retrospective cohort study[J].Reprod Biomed Online,2018,36(3):361-368.
[6]ZHANG Y,CHEN J,LU W,et al.Clinical characteristics of persistent ectopic pregnancy after salpingostomy and influence on ongoing pregnancy[J].J Obstet Gynaecol Res,2017,43(3):564-570.
[7]刘秀娟,马艳华,马月巧,等.2种不同术式治疗输卵管异位妊娠对患者再生育能力及妊娠结局的影响[J].淮海医药,2018,36(04):427-430.
[8]王玉东.2016年英国皇家妇产科医师学会及早期妊娠学会《异位妊娠的诊断和管理》指南解读[J].中国实用妇科与产科杂志,2017,32(09):916-919.
[9]付凤仙,叶红,苗杰.腹腔镜输卵管异位妊娠切开取胚术后输卵管通畅情况的探讨[J].中国微创外科杂志,2015,15(12):1080-1083.
[10]蒋倩颖,杨起楠,黄倩倩,等.腹腔镜下输卵管壶腹部妊娠切开取胚术两种止血方法的比较[J].广东医学,2016,37(S1):99-101.
[11]董国玲.腹腔镜下输卵管妊娠不同手术方式的对比研究[J].中国实用医药,2016,11(19):89-90.
[12]邱晓红,韩丽英,李荷莲.不同术式治疗输卵管妊娠后的生育结局研究[J].A study of the reproductive outcome after different surgical management of tubal pregnancy,2016,12(10):1022-1025.
[13]张华.甲氨蝶呤对输卵管妊娠腹腔镜保守手术治疗后持续性异位妊娠发生的影响分析[J].基层医学论坛,2018,22(19):2648-2649.
[14]谢亚辉.甲氨蝶呤在输卵管妊娠保守性手术中的应用分析[J].医学理论与实践,2011,24(21):2546-2547.
[15]MEHRZADI S,FATEMI I,ESMAEILIZADEH M,et al.Hepatoprotective effect of berberine against methotrexate induced liver toxicity in rats[J].Biomed Pharmacother,2017,97(10):233-239.
[16]HOWARD S,MCCORMICK J,PUI C,et al.Preventing and Managing Toxicities of High-Dose Methotrexate[J].Oncologist,2016,21(12):1471-1482.
[17]DEMIRYILMAZ I,SENER E,CETIN N,et al.Biochemically and histopathologically comparative review of thiamine's and thiamine pyrophosphate's oxidative stress effects generated with methotrexate in rat liver[J].Med Sci Monit,2012,18(12):475-481.
[18]CONDOUS G,KIRK E,LU C,et al.Diagnostic accuracy of varying discriminatory zones for the prediction of ectopic pregnancy in women with a pregnancy of unknown location[J].Ultrasound Obstet Gynecol,2005,26(7):770-775.
[2]KIRK E,PAPAGEORGHIOU A T,CONDOUS G,et al.The diagnostic effectiveness of an initial transvaginal scan in detecting ectopic pregnancy[J].Hum Reprod,2007,22(11):2824-2828.
[3]曾玲,黄洪萍,苏莉,等.β-HCG水平与宫外孕保守治疗的临床探讨[J].实用妇科内分泌电子杂志,2015,2(9):1-2.
[4]许少榆.不同水平β-HCG的异位妊娠采用药物保守治疗与腹腔镜保守手术的疗效分析[J].齐齐哈尔医学院学报,2017,38(08):879-881.
[5]MORSE A,SI W,QIN S,et al.Optimal use of peri-operative human chorionic gonadotrophin concentrations to identify persistent ectopic pregnancy after laparoscopic salpingostomy:a retrospective cohort study[J].Reprod Biomed Online,2018,36(3):361-368.
[6]ZHANG Y,CHEN J,LU W,et al.Clinical characteristics of persistent ectopic pregnancy after salpingostomy and influence on ongoing pregnancy[J].J Obstet Gynaecol Res,2017,43(3):564-570.
[7]刘秀娟,马艳华,马月巧,等.2种不同术式治疗输卵管异位妊娠对患者再生育能力及妊娠结局的影响[J].淮海医药,2018,36(04):427-430.
[8]王玉东.2016年英国皇家妇产科医师学会及早期妊娠学会《异位妊娠的诊断和管理》指南解读[J].中国实用妇科与产科杂志,2017,32(09):916-919.
[9]付凤仙,叶红,苗杰.腹腔镜输卵管异位妊娠切开取胚术后输卵管通畅情况的探讨[J].中国微创外科杂志,2015,15(12):1080-1083.
[10]蒋倩颖,杨起楠,黄倩倩,等.腹腔镜下输卵管壶腹部妊娠切开取胚术两种止血方法的比较[J].广东医学,2016,37(S1):99-101.
[11]董国玲.腹腔镜下输卵管妊娠不同手术方式的对比研究[J].中国实用医药,2016,11(19):89-90.
[12]邱晓红,韩丽英,李荷莲.不同术式治疗输卵管妊娠后的生育结局研究[J].A study of the reproductive outcome after different surgical management of tubal pregnancy,2016,12(10):1022-1025.
[13]张华.甲氨蝶呤对输卵管妊娠腹腔镜保守手术治疗后持续性异位妊娠发生的影响分析[J].基层医学论坛,2018,22(19):2648-2649.
[14]谢亚辉.甲氨蝶呤在输卵管妊娠保守性手术中的应用分析[J].医学理论与实践,2011,24(21):2546-2547.
[15]MEHRZADI S,FATEMI I,ESMAEILIZADEH M,et al.Hepatoprotective effect of berberine against methotrexate induced liver toxicity in rats[J].Biomed Pharmacother,2017,97(10):233-239.
[16]HOWARD S,MCCORMICK J,PUI C,et al.Preventing and Managing Toxicities of High-Dose Methotrexate[J].Oncologist,2016,21(12):1471-1482.
[17]DEMIRYILMAZ I,SENER E,CETIN N,et al.Biochemically and histopathologically comparative review of thiamine's and thiamine pyrophosphate's oxidative stress effects generated with methotrexate in rat liver[J].Med Sci Monit,2012,18(12):475-481.
[18]CONDOUS G,KIRK E,LU C,et al.Diagnostic accuracy of varying discriminatory zones for the prediction of ectopic pregnancy in women with a pregnancy of unknown location[J].Ultrasound Obstet Gynecol,2005,26(7):770-775.