Rísquez F, Forman R, Maleika F, Foulot H, Reidy J, Chapman M, Zorn J R
Clinique Universitaire Baudelocque, Hôpital Cochin, Paris, France.
Fertil Steril. 1992 Dec;58(6):1131-5. doi: 10.1016/s0015-0282(16)55557-5.
To determine the efficacy of transcervical tubal cannulation and intraluminal methotrexate injection for the management of tubal ectopic pregnancy (EP).
Prospective multicenter study of 33 patients with tubal pregnancies.
Four university-based gynecology and radiology departments in three different countries: France, England, and Germany.
Thirty-three patients who presented with a clinical diagnosis of EP.
Patients underwent transcervical tubal cannulation under fluoroscopic or ultrasound control and local injection of methotrexate (up to 50 mg).
We evaluate the feasibility of transcervical tubal cannulation for the management of tubal pregnancy.
Two patients elected to withdraw from the protocol. In the remaining 31 patients there was complete resolution of the EP in 27 (87%). Surgery was performed in 4 patients. Seventeen patients, 14 of whom desired pregnancies, were available for follow-up to assess the return of reproductive potential. Seven of 7 patients who subsequently underwent hysterosalpingography had patency of the affected tube. Five patients later had an intrauterine pregnancy. One patient had an early miscarriage, two have given birth, and two singleton pregnancies are still ongoing. The remaining patients are symptom free.
This study demonstrates that transcervical tubal catheterization in patients with tubal pregnancies is feasible and can be performed without anesthesia or analgesia in most cases. Intraluminal methotrexate per se is capable of causing regression of the EP. This approach offers a new alternative for the treatment of selected patients with tubal EP.
确定经宫颈输卵管插管及管腔内注射甲氨蝶呤治疗输卵管异位妊娠（EP）的疗效。
对33例输卵管妊娠患者进行的前瞻性多中心研究。
法国、英国和德国三个不同国家的四所大学附属医院的妇产科和放射科。
33例临床诊断为EP的患者。
患者在透视或超声引导下接受经宫颈输卵管插管，并局部注射甲氨蝶呤（最大剂量50mg）。
评估经宫颈输卵管插管治疗输卵管妊娠的可行性。
2例患者选择退出研究方案。其余31例患者中，27例（87%）的EP完全消退。4例患者接受了手术。17例患者（其中14例有生育意愿）接受随访以评估生殖潜能的恢复情况。随后接受子宫输卵管造影的7例患者中，患侧输卵管通畅。5例患者后来发生宫内妊娠。1例患者早期流产，2例患者已分娩，2例单胎妊娠仍在继续。其余患者无症状。
本研究表明，输卵管妊娠患者行经宫颈输卵管插管是可行的，大多数情况下无需麻醉或镇痛即可进行。管腔内注射甲氨蝶呤本身能够使EP消退。这种方法为部分输卵管EP患者的治疗提供了一种新的选择。
