Sauer M V, Gorrill M J, Rodi I A, Yeko T R, Greenberg L H, Bustillo M, Gunning J E, Buster J E
Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, Torrance 90509.
Fertil Steril. 1987 Nov;48(5):752-5.
Unruptured tubal pregnancies diagnosed at laparoscopy were treated with either methotrexate/citrovorum factor (MTX/CF) (n = 21) or observation (n = 5). Entry criteria required that the ectopic pregnancy be visualized, less than or equal to 3 cm in diameter, with intact serosa and no active bleeding. Treatment selection was based upon preoperative levels of beta-human chorionic gonadotropin (beta-hCG), with MTX/CF given to subjects exhibiting a plateaued or rising pattern and observation alone given to those with falling levels. Twenty-five of 26 ectopic pregnancies resolved without need of laparotomy. Two subjects received blood transfusions and one required a second operation for intra-abdominal bleeding. In both cases, fetal cardiac activity was noted pretreatment on ultrasound. The authors conclude the following: (1) MTX/CF may be safely used to treat selected unruptured ectopic pregnancy; (2) many ectopic pregnancies resolve spontaneously; and (3) ectopic pregnancies that form fetal elements, as evidenced on ultrasound, should not be managed medically.
通过腹腔镜检查诊断出的未破裂输卵管妊娠患者，一部分接受了甲氨蝶呤/亚叶酸（MTX/CF）治疗（n = 21），另一部分接受了观察等待（n = 5）。纳入标准要求异位妊娠可被看到，直径小于或等于3厘米，浆膜完整且无活动性出血。治疗方案的选择基于术前β-人绒毛膜促性腺激素（β-hCG）水平，β-hCG水平呈平台期或上升趋势的患者接受MTX/CF治疗，β-hCG水平下降的患者则仅接受观察等待。26例异位妊娠中有25例无需剖腹手术即得以解决。2名患者接受了输血治疗，1名患者因腹腔内出血需要进行二次手术。在这两例中，超声检查均发现治疗前存在胎心活动。作者得出以下结论：（1）MTX/CF可安全用于治疗部分未破裂的异位妊娠；（2）许多异位妊娠可自行消退；（3）超声检查显示已形成胎儿结构的异位妊娠，不应采用药物治疗。
