Stovall T G, Ling F W, Gray L A, Carson S A, Buster J E
Department of Obstetrics and Gynecology, University of Tennessee, Memphis.
Obstet Gynecol. 1991 May;77(5):749-53.
In an ongoing clinical trial, 100 patients with an unruptured ectopic pregnancy of 3.5 cm or less in greatest dimension were treated with an outpatient protocol of methotrexate and citrovorum factor chemotherapy. Methotrexate and citrovorum were given on alternating days until the hCG titer had decreased by 15% on 2 consecutive days. The patients ranged in age from 16-40 years, gravidity from 1-8, and parity from 0-5. Twenty-three patients had a previous ectopic pregnancy. Of the 100 patients, 96 (96%) received methotrexate/citrovorum as primary therapy and four (4%) were treated for persistent hCG titers after a conservative surgical procedure. The tubal pregnancies of patient nos. 1-50 were confirmed by laparoscopy, whereas patient nos. 51-100 were diagnosed according to a nonlaparoscopic algorithm. Four patients of 100 failed medical therapy and required surgery. Of these, one had an ectopic pregnancy with cardiac activity, one ruptured after intercourse, and the remaining two cases had no specific identifiable risk factors. Of the ectopic pregnancies with cardiac activity, 80% were successfully treated. Five patients (5%) had methotrexate-related side effects, all after the fourth dose, but none required treatment for these side effects. Hysterosalpingograms done on 58 patients subsequently demonstrated tubal patency in 84.5% on the involved side. To date, 37 pregnancies have occurred in this group, of which 31 (89.2%) were intrauterine and four (10.8%) were recurrent ectopic pregnancies. We conclude that methotrexate/citrovorum is safe, effective, and helps to preserve reproductive performance when used as primary therapy for unruptured ectopic pregnancy and for treatment of persistent disease following a conservative surgical procedure.
在一项正在进行的临床试验中，100例最大直径为3.5厘米或更小的未破裂异位妊娠患者接受了甲氨蝶呤和亚叶酸钙化疗的门诊治疗方案。甲氨蝶呤和亚叶酸钙隔日给药，直到人绒毛膜促性腺激素（hCG）水平连续2天下降15%。患者年龄在16至40岁之间，孕次为1至8次，产次为0至5次。23例患者曾有过异位妊娠史。100例患者中，96例（96%）接受甲氨蝶呤/亚叶酸钙作为主要治疗，4例（4%）在保守性手术后因hCG水平持续升高而接受治疗。1至50号患者的输卵管妊娠通过腹腔镜检查确诊，而51至100号患者根据非腹腔镜算法诊断。100例患者中有4例药物治疗失败需要手术。其中，1例异位妊娠有心跳，1例在性交后破裂，其余2例没有可明确识别的危险因素。有心跳的异位妊娠中，80%成功治疗。5例患者（5%）出现与甲氨蝶呤相关的副作用，均在第四剂后出现，但均无需针对这些副作用进行治疗。随后对58例患者进行的子宫输卵管造影显示，患侧输卵管通畅率为84.5%。迄今为止，该组已发生37次妊娠，其中31次（89.2%）为宫内妊娠，4次（10.8%）为复发性异位妊娠。我们得出结论，甲氨蝶呤/亚叶酸钙作为未破裂异位妊娠的主要治疗方法以及保守性手术后持续性疾病的治疗方法是安全、有效的，并且有助于保留生殖功能。
