Kazandi M, Turan V
Department of Obstetrics and Gynecology, Ege University, Izmir, Turkey.
Clin Exp Obstet Gynecol. 2011;38(1):67-70.
The assessment of ectopic pregnancy, its risk factors and comparison of the treatment modalities. MATERIAL AND DESIGN: Between January 2002 and July 2009, 254 ectopic pregnancies were reviewed retrospectively at the Department of Obstetrics and Gynecology, Ege University. Complaints of patients, localizations of ectopic pregnancy and comparison of patients, whether they had medical therapy or surgery, were evaluated. Metotrexate (50 mg/m2 IM) was used in hemodinamically stable patients (hCG concentrations of patients varied between 450 IU/1 and 3660 IU/1). Patients with fetal cardiac activity and serum hCG concentrations higher than 5000 UI1, were treated surgically. Serum hCG concentrations were measured until the hormone was undetectable (< 1 IU/1).
Tubal ectopic pregnancy consisted of 95% of ectopic pregnancies in this trial. The most frequently seen symptom was abdominopelvic pain (77%). Ectopic pregnancy occurred in patients including those with a history of pelvic surgery (12%), previous ectopic pregnancy (6%), usage of intrauterine devices (6%), history of infertility (5.5%) and history of pelvic inflamatory disease (4%). While hemodynamically stable, 83 patients were given single dose methotrexate (50 mg/m2), and 165 patients were treated surgically. Totally 93 salpingectomies and 54 salpingostomies were performed. Of 83 patients administered single dose methotrexate, 69 were successfully treated with one course, six patients needed a second course and surgical intervention was performed in eight patients. On the other hand, of patients that underwent surgery, seven of the salpingostomy group needed methotrexate for persistent trophoblasts and three of this group were reoperated. The tube was preserved in 49 patients in the salpingostomy group (90.7%) versus 75 (92.8%) in the methotexate group (p: 0.916). When undetectable hCG levels following initial therapy were considered, no significant difference was found between the two treatment groups (p: 0.804).
In selected patients with low serum hCG concentrations systemic methotrexate is a good alternative. Early diagnosis of ectopic pregnancy improves medical therapy. Although salpingectomy solves the problem definitely, comprehensive studies are required concerning future fertility of salpingectomy patients compared with salpingostomy patients.
评估异位妊娠、其危险因素并比较治疗方式。
2002年1月至2009年7月期间，在伊兹密尔大学妇产科对254例异位妊娠进行了回顾性研究。评估了患者的主诉、异位妊娠的部位以及患者接受药物治疗或手术治疗的情况。对血流动力学稳定的患者（患者的hCG浓度在450 IU/1至3660 IU/1之间）使用甲氨蝶呤（50 mg/m²，肌内注射）。有胎心活动且血清hCG浓度高于5000 UI1的患者接受手术治疗。测量血清hCG浓度直至该激素检测不到（<1 IU/1）。
在本试验中，输卵管异位妊娠占异位妊娠的95%。最常见的症状是下腹盆腔疼痛（77%）。异位妊娠发生在有盆腔手术史（12%）、既往异位妊娠史（6%）、使用宫内节育器（6%）、不孕史（5.5%）和盆腔炎症病史（4%）的患者中。在血流动力学稳定的情况下，83例患者接受了单剂量甲氨蝶呤（50 mg/m²）治疗，165例患者接受了手术治疗。共进行了93例输卵管切除术和54例输卵管造口术。在接受单剂量甲氨蝶呤治疗的83例患者中，69例经一个疗程成功治疗，6例患者需要第二个疗程，8例患者接受了手术干预。另一方面，在接受手术的患者中，输卵管造口术组有7例患者因持续性滋养细胞需要甲氨蝶呤治疗，其中3例再次手术。输卵管造口术组49例患者（90.7%）的输卵管得以保留，甲氨蝶呤组为75例（92.8%）（p：0.916）。当考虑初始治疗后hCG水平检测不到时，两个治疗组之间未发现显著差异（p：0.804）。
在血清hCG浓度较低的选定患者中，全身应用甲氨蝶呤是一个不错的选择。异位妊娠的早期诊断可改善药物治疗效果。虽然输卵管切除术能彻底解决问题，但与输卵管造口术患者相比，需要对输卵管切除术患者未来的生育能力进行全面研究。
