钟小燕+黄英+陈君玉+席予凡

摘 要 目的：探讨甲氨蝶呤联合米非司酮对异位妊娠患者再次妊娠的影响。方法：选取异位妊娠患者120例随机分成观察组和对照组各60例。观察组予以甲氨蝶呤联合米非司酮治疗，对照组则单纯以甲氨蝶呤治疗，随访1年。比较两组患者再次宫内妊娠率、治疗总成功率、血HCG值转阴时间、包块消失时间、阴道出血时间及不良反应发生情况。结果：观察组患者的再次宫内妊娠率、治疗总成功率和输卵管通畅率明显高于对照组（P<0.05）。观察组血HCG值转阴时间、包块消失时间、阴道出血时间均较对照组短（P<0.05）。两组不良反应发生率比较差异无统计学意义。结论：甲氨蝶呤联合米非司酮治疗异位妊娠患者可显著提高患者的再次宫内妊娠率，缩短患者疗程和恢复时间，提高患者治疗成功率。

关键词 甲氨蝶呤 米非司酮 异位妊娠 再次妊娠

中图分类号：R979.22； R714.22 文献标识码：A 文章编号：1006-1533（2016）21-0017-03

Effect of methotrexate combined with mifepristone in the treatment of the re-pregnancy of 60 cases of patients with ectopic pregnancy*

ZHONG Xiaoyan**， HUANG Ying， CHEN Junyu， XI Yufan（The First Maternity and Child Care Hospital of Huizhou City， Huizhou 516000， China）

ABSTRACT Objective： To discuss the effect of methotrexate combined with mifepristone in the treatment of the repregnancy of patients with ectopic pregnancy. Methods： One hundred and twenty cases of the patients were randomly divided into an observation group and a control group with 60 cases each. The observation group was treated with methotrexate combined with mifepristone， while the control group with only methotrexate. Both groups were followed-up for 1 year. The re-pregnancy rate， total success rate of treatment， clearance time of blood HCG value， packet- disappeared time， vaginal bleeding time and adverse reactions were compared. Results： The re-pregnancy rate， the total success rate of treatment and the tubal patency rate were significantly higher in the observation group than in the control group （P<0.05）. The clearance time of blood HCG value， packet-disappeared time， vaginal bleeding time were shorter in the observation group than in the control group. The comparison of the incidence of adverse reaction between the two groups showed no statistical significance. Conclusion： Methotrexate combined with mifepristone can significantly increase the re-pregnancy rate and the success rate of treatment and shorten the duration of treatment and recovery.

KEY WORDS methotrexate； mifepristone； ectopic pregnancy； re-pregnancy

受精卵在子宫体腔外着床称为异位妊娠、宫外孕，其中以输卵管妊娠多见，占95%左右[1]。原因多为输卵管管腔或周围发生炎症，引起管腔狭窄，阻碍受精卵的正常运行，使受精卵在输卵管内停留着床发育，最终导致输卵管妊娠流产或破裂[2]。宫外孕是妊娠最容易导致妇女死亡的主要原因之一， 近年来，随着医学的发展，宫外孕的治疗除手术外，保守治疗也因其创伤小而渐渐受到重视[3-4]。本文通过研究探讨甲氨蝶呤联合米非司酮对异位妊娠患者再次妊娠的影响，现报道如下。

1 资料与方法

1.1 一般资料

选取2014年3月—2016年1月我院收治的异位妊娠患者120例。所有患者均经我院临床诊断为异位妊娠，且患者自愿接受保守治疗。纳入标准：患者同时满足以下条件：①无药物治疗的禁忌证；②输卵管妊娠未发生破裂；③妊娠囊直径≤4 cm；④血b-HCG<2 000 mIU/L。排除标准：①生命体征不稳定；……