Alvarez-Sarrado Leticia, De Bonrostro-Torralba Carlos, Espiau-Romera Andrea, Benito-Vielba Marta, Lasierra-Beamonte Ana, Campillos-Maza Jose Manuel
Maternal-Fetal Medicine Unit, Department of Obstetrics, Miguel Servet Maternal University Hospital, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain.
Eur J Obstet Gynecol Reprod Biol. 2020 Aug;251:180-183. doi: 10.1016/j.ejogrb.2020.05.067. Epub 2020 May 30.
To evaluate the efficacy and safety of combined-therapy with ultrasound guided intrasacular injection of 50 mg of methotrexate (MTX) and a 50 mg/m dose of systemic MTX in uncomplicated ectopic pregnancies with ultrasonographic evidence of embryonic structures in the gestational sac.
We designed a retrospective study including 60 patients to assess the efficacy of combined MTX treatment and to determine which clinical or ultrasonographic variables could be associated with successful medical treatment. Failed medical treatment was defined when surgery was needed. For statistical analysis, we developed a descriptive analysis and a univariate logistic regression study.
Medical approach was effective in 73.3 % of patients. MTX treatment was successful in 32 (68.1 %) out of 47 tubal pregnancies None of the 4 cervical or 2 abdominal pregnancies required surgery. Six (85.7 %) out of 7 cornual pregnancies were successfully treated. No statistically significant differences were found in the success rates according to clinical data, ultrasound or analytic characteristics of women.
Combined MTX therapy could be an effective and safe alternative in ectopic pregnancies with embryo in hemodynamically stable women. Clinical, ultrasound or analytic characteristics of patients should not entail a contraindication. In locations where surgery implies a technical difficulty, this option may decrease morbimortality rates frequently associated to a more invasive alternative.
评估超声引导下向孕囊内注射50mg甲氨蝶呤（MTX）与50mg/m剂量的全身MTX联合治疗血流动力学稳定的单纯性异位妊娠且孕囊内有胚胎结构超声证据的疗效和安全性。
我们设计了一项回顾性研究，纳入60例患者，以评估MTX联合治疗的疗效，并确定哪些临床或超声变量可能与药物治疗成功相关。若需要手术，则定义为药物治疗失败。为进行统计分析，我们开展了描述性分析和单因素逻辑回归研究。
73.3%的患者药物治疗有效。47例输卵管妊娠中有32例（68.1%）MTX治疗成功。4例宫颈妊娠和2例腹腔妊娠均无需手术。7例宫角妊娠中有6例（85.7%）成功治疗。根据女性的临床数据、超声或分析特征，成功率未发现统计学显著差异。
对于血流动力学稳定且孕囊内有胚胎的异位妊娠患者，MTX联合治疗可能是一种有效且安全的选择。患者的临床、超声或分析特征不应成为禁忌证。在手术存在技术困难的情况下，该选择可能会降低与更具侵入性的替代方案相关的病死率。
