摘要
目的观察经阴道超声(TVS)引导异位妊娠囊穿刺注射氨甲喋呤(MTX)加α-糜蛋白酶治疗宫外孕的疗效。方法将200例未破裂型宫外孕患者随机分成两组,A组120例,B组80例。A组:在TVS引导下,应用21G长20cm穿刺针穿刺异位妊娠囊,抽净囊液后,将MTX 40mg加α-糜蛋白酶5mg用生理盐水2ml溶解后与抽出囊液的量等量注入妊娠囊内; B组:用同样方法将MTX 40mg用生理盐水2ml溶解后与抽出囊液的量等量注入妊娠囊内,观察比较两组疗效。结果 A组1次治愈108例(90. 0%),3d超声复查,妊娠囊缩小,胚芽及原始心管搏动消失,血β-hCG降低,1～3个月超声复查囊块消失; 2次治疗成功9例(7. 5%);无效3例(2.5%),改为手术治疗,总治愈率97. 5%(120/117)。输卵管通管试验102例通畅,15例通而不畅,经后穹隆穿刺注射丁胺卡那霉素0. 2g及α-糜蛋白酶治疗3次,输卵管超声造影通畅。B组1次治愈59例(73. 8%),无效21例(26. 3%),其中破裂6例,改为手术治疗,另15例治疗后无效,改用A组方法治疗,A组疗效与B组比较,差异有显著性(P <0. 05)。结论 TVS引导异位妊娠囊穿刺注射MTX加α-糜蛋白酶治疗宫外孕,可防止输卵管粘连,保持输卵管通畅,提高治疗成功率,且损伤小,治愈时间短,是一种有效的治疗方法。
Objective To discuss the efficacy of transvaginal ultrasonography-guided puncture the ectopic pregnancy sac and injection of methotrexate combined with α-chymotrypsin treatment of ectopic pregnancy. Methods Two hundred cases of early unruptured ectopic pregnancy patients were randomly divided into two groups,A group of 120 cases,B group of 80 cases. In group A,under transvaginal ultrasonographyguided,the ectopic pregnancy sacs were punctured and and fluid aspirated by the application of 21 G 20 cm,then 40 mg MTX combined with 5 mg α-chymotrypsin dissolved in 2 ml saline was injected in the ectopic pregnancy sac,the liquid quantity of injection and aspiration would be equal. In group B,40 mg MTX dissolved in 2 ml saline was injected in the ectopic pregnancy sac by the same way,the liquid quantity of injection and aspiration would be equal. The therapeutic effect was compared between the two groups. Results One hundred and eight cases were complete treatment in one-time cure in A group( 90. 0%),the pregnancy sacs were reduced combined with the embryo and the beat of primitive heart tube were disappeared on ultrasound 3 days after the application,the blood β-HCG were lower. After 2 or 3 months,the sacs were disappeared. Nine cases were complete treatment in secondary cure( 7. 5%),3 cases were invalid instead of operative treatment. The total cure rate was 97. 5%( 120/117). The tubal patency test showed 102 patients were unobstructed and 15 patients were partially obstructed. After three times injecting the amikacin 0. 2 g and α-chymotrypsin,the 15 patients were unobstructed. Fifty-nine cases were complete treatment in one-time cure in B group( 73. 8%),twenty-one cases were invalid( 26. 3%),six cases which were ruptured instead of operative treatment. In addition,fifteen cases were invalid after treatment,then used A group method. The difference between two groups was significance( P < 0. 05). Conclusion Injection of methotrexate combined with α-chymotrypsin play synergistic effect in treatment of ectopic pregnancy,in order to prevent to the tubal adhesions and improve the cure rate. It is an effective method.
作者
李丹丹
高振森
寇广玲
LI Dandan;GAO Zhensen;KOU Guangling(Department of Ultrasound ,Weifang People's Hospital ,Weifang261041,China)
出处
《潍坊医学院学报》
2018年第5期337-339,368,共4页
Acta Academiae Medicinae Weifang
关键词
宫外孕
经阴道超声
氨甲喋呤
妊娠囊
Α-糜蛋白酶
Ectopic pregnancy
Transvaginal sonography
Methotrexate
Ectopic pregnancy sac
α-chymotrypsin
