3种保守治疗方法治疗输卵管妊娠的应用价值

doi:10.3877/cma.j.issn.1673-5250.2012.02.009

目的

探讨3种保守方法治疗输卵管妊娠(TP)的疗效及其在临床中的应用价值。

方法

选择2005年10月至2010年8月在本院就诊并确诊为TP的274例患者为研究对象。将其按就诊顺序随机分为3组，分别接受3种方式治疗：介入组(n＝94)，MTX(甲氨蝶呤)组(n＝89)及5－Fu(氟尿嘧啶)组(n＝91)。分别比较3种保守治疗方式的疗效、不良反应发生率、住院费用和时间等。对有生育要求者分别于治疗结束半年后行输卵管碘油造影(HSG)，了解输卵管通畅度及生育情况(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准，得到该委员会批准，分组征得受试者的知情同意，并与其签署临床研究知情同意书)。3组患者的年龄、停经时间、治疗前血清β－人绒毛膜促性腺激素(hCG)水平、阴道流血时间和孕囊直径比较，差异无统计学意义(P>0.05)。

结果

介入组治疗成功率(100.00%, 94/94)明显高于MTX组(75.28%，67/89)及5－Fu组(79.12%，72/91)，组间比较，差异有统计学意义(P<0.01)。各组治疗后要求保留生育功能的患者，于治疗结束半年后进行患侧输卵管HSG，3组输卵管通畅率(阻塞率)比较，差异无统计学意义(P>0.05)，但介入治疗对生育功能的影响最小，3组患者生育功能比较，差异有统计学意义(P<0.01)。

结论

3种保守治疗方法对TP的治疗均有一定效果。其中，介入治疗的疗效最好，但对设备及技术要求更高，费用亦高，在基层医院难于推广。故MTX肌内注射及5－Fu静脉滴注治疗TP，仍是基层医院治疗TP的较好方法。

关键词: 保守治疗, 输卵管妊娠

Objective

To explore three kinds of conservative methods to treat tubal pregnancy (TP) and its application value in clinical effects.

Methods

A total of 274 patients who were diagnosed as TP from October 2005 to August 2010 in our hospital were included into this study. They were divided into three groups randomly and received three kinds of treatment methods, intervention group (n=94), MTX (methotrexate) group (n=89) and 5-Fu (fluorouracil) group (n=91). The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Affiliated Hospital of North Sichuan Medical College. Informed consent was obtained from each patient. Curative effects, adverse effects, expenses and hospitalized time were compared among three groups. After half a year of the treatment, patients with fertility requirement underwent hysterosalpingogram(HSG) requirements at sixth month after operation, in order to find out oviduct tubes unobstructed degrees. There had no significant difference among three groups on patients' age, menopause time, serum β-hCG level before treatment, vaginal bleeding time and pregnant capsule diameter (P>0.05).

Results

The successful rate in intervention group (100.00%, 94/94) was significantly higher than that of MTX group (75.28%, 67/89) and 5-Fu group (79.12%, 72/91) (P<0.01). There had no significant difference of tubal patency rate at sixth months after treatment among three groups (P>0.05). But intervention treatment had the minimal impact on reproductive functions. There had significant difference of reproductive function among three groups (P<0.01).

Conclusions

Three kinds of conservative treatment of TP have certain effects. Among them, the curative effect of interventional treatment is the best, but the equipment and technology requirements are higher, and the cost is also high. MTX (muscle injection) and 5-Fu (intravenous drip) are still better methods in the treatment of TP at the basic-level hospital.

Key words: conservative treatment, tubal pregnancy

表1 3组保守治疗成功率比较[n(%)]

Table 1 Comparison of successful rate after conservative treatment among three groups [n(%)]

组别	n	成功率
介入组	94	94(100.00)
MTX组	89	67 (75.28)
5－Fu组	91	72 (79.12)

表1 3组保守治疗成功率比较[n(%)]

Table 1 Comparison of successful rate after conservative treatment among three groups [n(%)]

组别	n	成功率
介入组	94	94(100.00)
MTX组	89	67 (75.28)
5－Fu组	91	72 (79.12)

表2 3组治疗成功患者血清β－hCG水平降至正常所需时间比较[d, n(%)]

Table 2 Comparison of time of serum β－hCG level decreased to normal among patients with successful conservative treatment in three groups[d, n(%)]

组别	n	5～7	8～14	15～21	22～28	中位数
介入组	94	13(13.83)	36(38.30)	31(33.98)	14(14.89)	13
MTX组	67	0 (0.00)^a	14(20.90)^c	38(56.72)^c	15(22.39)^c	16^d
5－Fu组	72	0 (0.00)^ab	19(26.39)^bc	41(56.94)^bc	12(16.67)^bc	16^d

表2 3组治疗成功患者血清β－hCG水平降至正常所需时间比较[d, n(%)]

Table 2 Comparison of time of serum β－hCG level decreased to normal among patients with successful conservative treatment in three groups[d, n(%)]

组别	n	5～7	8～14	15～21	22～28	中位数
介入组	94	13(13.83)	36(38.30)	31(33.98)	14(14.89)	13
MTX组	67	0 (0.00)^a	14(20.90)^c	38(56.72)^c	15(22.39)^c	16^d
5－Fu组	72	0 (0.00)^ab	19(26.39)^bc	41(56.94)^bc	12(16.67)^bc	16^d

图1 输卵管妊娠保守治疗后血清β－hCG变化曲线

Figure 1 Change trend of blood β－hCG value curve after receiving tubal pregnancy conservative treatment

表3 3组保守治疗成功患者术后阴道流血时间比较[n(%)]

Table 3 Comparison of duration time of vaginal bleeding after conservative treatment among patients with successful in three groups [n(%)]

组别	n	7～9	10～14	15～20	21～27	中位数
介入组	94	14(14.89)	39(41.50)	36(38.30)	5 (5.32)	14
MTX组	67	1 (1.49)^a	18(26.87)^c	33(49.25)^c	15(22.39)^a	17^d
5－Fu组	72	3 (4.17)^ab	18(25.00)^bc	37(51.39)^bc	14(19.44)^ab	17^d

表3 3组保守治疗成功患者术后阴道流血时间比较[n(%)]

Table 3 Comparison of duration time of vaginal bleeding after conservative treatment among patients with successful in three groups [n(%)]

组别	n	7～9	10～14	15～20	21～27	中位数
介入组	94	14(14.89)	39(41.50)	36(38.30)	5 (5.32)	14
MTX组	67	1 (1.49)^a	18(26.87)^c	33(49.25)^c	15(22.39)^a	17^d
5－Fu组	72	3 (4.17)^ab	18(25.00)^bc	37(51.39)^bc	14(19.44)^ab	17^d

表4 3组治疗成功患者接受保守治疗后1，2及3个月时病灶完全被吸收率比较[n(%)]

Table 4 Comparison of complete absorption rate of patients with successful conservative treatment in three groups at different period[n(%)]

组别	n	1个月	2个月	3个月
介入组	37	6(16.16)	24(64.86)	7(18.92)
MTX组	22	3(13.64)	14(63.64)	5(22.73)
5－Fu组	24	3(12.50)	16(66.67)	5(20.83)

表4 3组治疗成功患者接受保守治疗后1，2及3个月时病灶完全被吸收率比较[n(%)]

Table 4 Comparison of complete absorption rate of patients with successful conservative treatment in three groups at different period[n(%)]

组别	n	1个月	2个月	3个月
介入组	37	6(16.16)	24(64.86)	7(18.92)
MTX组	22	3(13.64)	14(63.64)	5(22.73)
5－Fu组	24	3(12.50)	16(66.67)	5(20.83)

表5 3组患者治疗后半年输卵管通畅情况比较(n'：为要求行HSG检查的输卵管条数)[n' (%)]

Table 5 Comparison of the situation of oviduct tubes unobstructed after half a year of conservative treatment among three groups (n' was the number of requirements of article HSG fallopian tube) [n' (%)]

组别	n	n'	通畅	通而不畅	阻塞
介入组	94	32	21(65.63)	5(15.63)	6(18.75)
MTX组	89	21	13(61.90)^a	3(14.29)^a	5(23.81)^a
5－Fu组	91	24	15(62.50)^ab	4(16.67)^ab	5(20.83)^ab

表5 3组患者治疗后半年输卵管通畅情况比较(n'：为要求行HSG检查的输卵管条数)[n' (%)]

组别	n	n'	通畅	通而不畅	阻塞
介入组	94	32	21(65.63)	5(15.63)	6(18.75)
MTX组	89	21	13(61.90)^a	3(14.29)^a	5(23.81)^a
5－Fu组	91	24	15(62.50)^ab	4(16.67)^ab	5(20.83)^ab

表6 3组患者治疗后不良反应发生率比较[n(%)]

Table 6 Comparison of rates of adverse effects after treatment among three groups [n(%)]

组别	n	恶心、呕吐	头发脱落	血象下降	口腔溃疡
介入组	94	9 (9.57)^a	1 (1.64)^a	0 (0.00)^a	0 (0.00)^a
MTX组	89	24(26.97)^c	16(17.98)^c	33(37.08)^c	27(30.34)^c
5－Fu组	91	81(89.01)^ac	34(37.36)^ac	44(48.35)^ac	26(28.57)^bc

表6 3组患者治疗后不良反应发生率比较[n(%)]

Table 6 Comparison of rates of adverse effects after treatment among three groups [n(%)]

组别	n	恶心、呕吐	头发脱落	血象下降	口腔溃疡
介入组	94	9 (9.57)^a	1 (1.64)^a	0 (0.00)^a	0 (0.00)^a
MTX组	89	24(26.97)^c	16(17.98)^c	33(37.08)^c	27(30.34)^c
5－Fu组	91	81(89.01)^ac	34(37.36)^ac	44(48.35)^ac	26(28.57)^bc

表7 3组患者平均住院费用及平均住院时间比较(±s)

Table 7 Comparison of average charge and hospital time among three groups (±s)

组别	n	住院费用(元)	平均住院时间(d)
介入组	94	6370.56±432.56	11.00±2.55
MTX组	89	1896.27±149.37	9.16±3.03
5－Fu组	91	2648.34±236.26	10.27±3.17

表7 3组患者平均住院费用及平均住院时间比较(±s)

Table 7 Comparison of average charge and hospital time among three groups (±s)

组别	n	住院费用(元)	平均住院时间(d)
介入组	94	6370.56±432.56	11.00±2.55
MTX组	89	1896.27±149.37	9.16±3.03
5－Fu组	91	2648.34±236.26	10.27±3.17

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Application Value of Three Kinds of Methods of Conservative Treatment on Tubal Pregnancy

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Application Value of Three Kinds of Methods of Conservative Treatment on Tubal Pregnancy