Tang Amy, Baartz David, Khoo Soo Keat
Department of Obstetrics and Gynaecology, University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia.
Aust N Z J Obstet Gynaecol. 2006 Apr;46(2):107-11. doi: 10.1111/j.1479-828X.2006.00537.x.
Medical treatment of the rare interstitial ectopic pregnancy with methotrexate has been considered an alternative to surgical resection.
To determine the treatment success rate with a single-dose intravenous methotrexate/folinic acid regimen and to identify predictors of treatment outcome.
A 5-year audit (April 2000-August 2005) was carried out, collecting clinical imaging data and serum beta-human chorionic gonadotrophin (beta-hCG). Time taken for complete beta-hCG resolution was recorded, and a negative beta-hCG result was used as an endpoint of successful outcome.
Of the 13 cases, two required urgent surgery for rupture on presentation. In the remaining 11 cases, intravenous methotrexate (300 mg) was used, with oral folinic acid rescue (15 mg x 4 doses). There were no side-effects. Complete beta-hCG resolution was achieved in 10 of the 11 medically treated cases (91% success rate), requiring 21-129 days. Successful outcome was seen with initial beta-hCG level as high as 106 634 IU/L and gestation sac as large as 6 cm and a live fetus.
The methotrexate/folinic acid regimen used as a one-dose treatment is safe and effective for unruptured interstitial pregnancy, with no side-effects and the advantage of avoiding invasive surgery. Subsequent tubal patency and reproductive function are yet to be ascertained.
甲氨蝶呤药物治疗罕见的间质部异位妊娠被认为是手术切除的一种替代方法。
确定单剂量静脉注射甲氨蝶呤/亚叶酸方案的治疗成功率，并确定治疗结果的预测因素。
进行了一项为期5年的审核（2000年4月至2005年8月），收集临床影像数据和血清β-人绒毛膜促性腺激素（β-hCG）。记录β-hCG完全消退所需的时间，β-hCG结果为阴性作为成功结局的终点。
13例患者中，2例就诊时因破裂需要紧急手术。其余11例采用静脉注射甲氨蝶呤（300mg），口服亚叶酸解救（15mg×4剂）。无副作用。11例接受药物治疗的患者中有10例β-hCG完全消退（成功率91%），所需时间为21至129天。初始β-hCG水平高达106634IU/L、妊娠囊大至6cm且有活胎的情况下也获得了成功结局。
单剂量治疗使用的甲氨蝶呤/亚叶酸方案对未破裂的间质部妊娠安全有效，无副作用且具有避免侵入性手术的优点。后续的输卵管通畅情况和生殖功能尚待确定。
