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目的探讨超声引导下经阴道侧穹窿注射甲氨蝶呤(methotr exate,MTX)治疗早期未破裂型输卵管妊娠的价值。方法对60例未破裂型输卵管妊娠进行超声引导下经阴道侧穹窿胚囊周围或胚囊内穿刺注射MTX50mg,杀胚治疗作研究组;与同期行传统的MTX肌内注射结合米非司酮口服治疗(治疗方案:MTX20mg肌内注射,5d,米非司酮50mg2次/d,6d)的60例未破裂型输卵管妊娠作对照组,比较两组血β-HCG下降幅度、保守治疗期限及重复性异位妊娠的发生率。结果研究组超声引导下MTX未破裂型输卵管妊娠肿块穿刺注射药物准确率100%,胚囊大小(7.5±5.38)mm,胚囊内注射成功率40%,胚囊周围注射成功率60%,总治疗成功率96.7%。注射MTX后,超声表现为胚囊变形、缩小、最后消失,胚囊周围滋养层血流显著减少、直至消失,约3～6周后宫外孕肿块消失。结论超声引导下经阴道侧穹窿穿刺注射MTX治疗输卵管妊娠,操作较简便,损伤较小,局部给药浓度高,疗效较好,疗程较短,有一定的临床价值。
Objective To investigate the value of ultrasound-guided methotrexate (MTX) in the treatment of early unruptured tubal pregnancy. Methods Sixty cases of unruptured tubal pregnancy underwent ultrasound guided transvaginal injection into the vaginal vault or embryo sac puncture MTX50mg, killing embryo treatment for the study group; with the same period conventional MTX intramuscular injection combined with mifepristone oral Sixty patients with unruptured tubal pregnancy treated with MTX20mg intramuscular injection (5 days, mifepristone 50mg2 times / d, 6d) were used as the control group. The decline in serum β-HCG, the duration of conservative treatment and the repetition The incidence of sexual ectopic pregnancy. Results The accuracy of ultrasound-guided MTX unruptured tubal pregnancy was 100%, the size of embryo sac was (7.5 ± 5.38) mm, the success rate of embryo sac injection was 40%, the success rate of injection around embryo sac was 60% Treatment success rate of 96.7%. After injection of MTX, ultrasound showed embryo sac deformation, reduced, and finally disappeared, the trophoblast blood flow around the embryo sac significantly reduced until disappear, about 3 to 6 weeks after the ectopic pregnancy lump disappeared. Conclusions Transvaginal injection of MTX for transvaginal culm puncture leads to tubal pregnancy. The operation is simple and convenient, the damage is small, the concentration of local administration is high, the curative effect is good, the course of treatment is short, and it has certain clinical value.