Czuczwar Piotr
3rd Department of Gynecology, Medical University of Lublin, Lublin, Poland.
J Ultrason. 2018;18(73):158-161. doi: 10.15557/JoU.2018.0023.
Medical management of ectopic pregnancy with methotrexate, an antimetabolite of folic acid, is an important alternative to surgical treatment, as it ensures a similar outcome whilst being far less invasive. Ultrasound evaluation does not only facilitate an accurate diagnosis, but also helps to select patients most likely to benefit from methotrexate treatment, as opposed to those with a high likelihood of failure of medical management, who are thus eligible for primary surgical treatment. Ultrasound also allows to monitor the outcome of methotrexate therapy. This study is a review of literature regarding the management of ectopic pregnancy with methotrexate. Such ultrasound findings as the size of the ectopic mass, presence of fetal heart rate and free fluid have been confirmed as effective eligibility criteria for therapy with methotrexate. In the future, possibly also endometrial stripe thickness and the vascularity of the ectopic mass may be considered predictive of successful methotrexate therapy. The initial increase in size of the ectopic mass following methotrexate therapy confirms its effectiveness, and should not prompt concern.
使用叶酸拮抗剂甲氨蝶呤对异位妊娠进行药物治疗是手术治疗的重要替代方法，因为它能确保相似的治疗效果，同时侵入性小得多。超声评估不仅有助于准确诊断，还能帮助选择最有可能从甲氨蝶呤治疗中获益的患者，而那些药物治疗失败可能性高的患者则适合进行初次手术治疗。超声还可用于监测甲氨蝶呤治疗的效果。本研究是关于用甲氨蝶呤治疗异位妊娠的文献综述。诸如异位包块大小、胎心搏动及游离液体等超声表现已被确认为甲氨蝶呤治疗的有效适应证标准。未来，子宫内膜厚度及异位包块的血管情况可能也被视为甲氨蝶呤治疗成功的预测指标。甲氨蝶呤治疗后异位包块大小最初的增加证实了其有效性，不应引起担忧。
