齐红明

【摘要】 目的：观察腹腔镜联合甲氨蝶呤治疗输卵管异位妊娠的临床效果，分析其对患者卵巢功能、输卵管再通的影响。方法：将2017年1月-2018年4月在本院接受治疗的100例输卵管妊娠患者作为研究对象。根据患者入院先后顺序将其分为对照组与研究组，各50例。两组患者均接受腹腔镜下开窗取胚术，研究组在此基础上联合甲氨蝶呤局部注射治疗，对两组患者的疗效情况及异位妊娠再发率进行分析比较。结果：研究组治疗总有效率为96.00%，明显高于对照组的76.00%。研究组疗效明显优于对照组，差异有统计学意义（P<0.05）。治疗后1、3个月，两组患者FSH、LH水平比较，差异均无统计学意义（P>0.05）。治疗后1、2周，研究组血清β-hCG水平均明显低于对照组，差异均有统计学意义（P<0.05）。研究組患者术后输卵管再通率为66.00%，明显高于对照组的44.00%，不通率12.00%明显低于对照组的30.00%，差异均有统计学意义（P<0.05）。术后随访1年，对照组6例（12.00%）患者出现再发异位妊娠，研究组未出现再发异位妊娠情况，研究组异位妊娠再发率明显低于对照组，差异有统计学意义（P<0.05）。结论：腹腔镜联合甲氨蝶呤可以有效提高输卵管异位妊娠患者输卵管再通率，降低输卵管妊娠再发率，且对患者卵巢功能无明显影响。

【关键词】 腹腔镜 甲氨蝶呤 输卵管异位妊娠 卵巢功能 疗效

Effect of Minimally Invasive Laparoscopy Combined with Methotrexate on Ovarian Function in Patients with Ectopic Tubal Pregnancy/QI Hongming. //Medical Innovation of China， 2021， 18（07）： 0-031

[Abstract] Objective： To observe the clinical effect of laparoscopy combined with Methotrexate in the treatment of ectopic tubal pregnancy， and to analyze its influence on ovarian function and fallopian tube recanalization. Method： A total of 100 patients with tubal pregnancy who received treatment in our hospital from January 2017 to April 2018 were selected as the research subjects. According to the order of admission， the patients were divided into control group and research group， 50 cases in each group. Patients in both groups received laparoscopic fenestration for embryo extraction， and the research group received combined local injection of Methotrexate on this basis. The curative effect and the recurrence rate of ectopic pregnancy were analyzed and compared between the two groups. Result： The total effective rate of the study group was 96.00%， significantly higher than 76.00% of the control group. The therapeutic effect in the study group was significantly better than that in the control group， the difference was statistically significant （P<0.05）. 1 and 3 months after treatment， there were no statistical significance in FSH and LH levels between two groups （P>0.05）. 1 and 2 weeks after treatment， serum β-hCG levels in the study group were significantly lower than those in the control group， with statistical significance （P<0.05）. The rate of tubal recanalization in the study group was 66.00%， which was significantly higher than 44.00% in the control group， and the rate of obstruction was 12.00%， which was significantly lower than 30.00% in the control group， the difference was statistically significant （P<0.05）. After 1 year of follow-up， 6 patients （12.00%） in the control group had recurrent ectopic pregnancy， while in the study group， there was no recurrence of ectopic pregnancy. The recurrence rate of ectopic pregnancy in the study group was significantly lower than that in the control group， the difference was statistically significant （P<0.05）. Conclusion： Laparoscopy combined with Methotrexate can effectively improve the tubal recanalization rate in patients with ectopic tubal pregnancy， reduce the recurrence rate of tubal pregnancy， and have no obvious effect on the ovarian function of patients， with high safety.

[Key words] Laparoscopy Methotrexate Ectopic tubal pregnancy Ovarian function The curative effect

First-authors address： Dandong Central Hospital， Dandong 118002， China

doi：10.3969/j.issn.1674-4985.2021.07.007

近年来随着二胎政策开放，我国高龄产妇明显增多，异位妊娠发病率逐年上升[1]。异位妊娠是妊娠期的常见病症，其中输卵管异位妊娠最为常见[2]。其特征在于患者卵子在输卵管壶腹部受精，并在输卵管着床、发育[3]，主要症状表现包括停经后下腹痛、附件区异常包块、阴道流血等[4]。随着腹腔镜微创技术的普及应用，通过腹腔镜下输卵管开窗取胚术可以保留患侧输卵管，满足患者的生育需求[5]。但单纯的手术治疗，患者在术后可能出现输卵管粘连，导致再发异位妊娠或不孕等情况[6]。甲氨蝶呤是抗叶酸类代谢药，可以抑制细胞的生长、繁殖从而起到终止妊娠的效果[7]。本次研究旨在探讨腹腔镜联合甲氨蝶呤对输卵管妊娠患者卵巢功能、输卵管再通的影响，选取100例患者展开调查研究，现报道如下。……