Osada Hisao, Teramoto Shokichi, Kaijima Hirotsune, Segawa Tomoya, Nagaishi Masaji, Shozu Makio, Kato Keiichi
Natural ART Clinic Nihombashi, 8F Tokyo Nihombashi Tower, 2-7-1 Nihombashi, Chuo-ku, Tokyo 103-6008, Japan.
Minatomirai Yume Clinic, 2F MM Park Building, 3-6-3 Minatomirai, Nishi-ku, Yokohama-shi, Kanagawa 220-0012, Japan.
Biomedicines. 2020 Jul 9;8(7):202. doi: 10.3390/biomedicines8070202.
Methotrexate has been the main mode of non-surgical treatment for ectopic pregnancies. However, we have developed an easier, repeatable method that can be applied even to patients with a high beta-human chorionic gonadotropin (β-hCG) level and/or positive fetal heartbeat, by targeting chorionic villi with a transvaginal injection of absolute ethanol (AE) into the lacunar space (intervillous space). The efficacy and safety of this method were examined in 242 cases of ectopic pregnancy, including 103 with positive fetal heartbeat. Serum β-hCG level was measured at frequent intervals, and transvaginal ultrasonography was performed to observe the gestational sac and hyperechoic inner ring. Of the 242 patients, 222 (91.7%) were successfully treated. The average number of AE injection(s) required was 1.6 (range: 1-5), and the average dose was 3.2 mL. After the treatment, many of the patients tried to conceive again, and 63 of the traceable 145 patients (43.4%), who had fallopian tube pregnancy, and 7 of the traceable 12 patients (58.3%), who had cervical or cesarean scar pregnancies, successfully conceived and delivered babies with no observed side effects. Therefore, this method could be an effective treatment for ectopic pregnancy with the potential to replace conventional surgical interventions and medical treatment using methotrexate.
甲氨蝶呤一直是异位妊娠非手术治疗的主要方式。然而，我们开发了一种更简便、可重复的方法，通过经阴道向绒毛间隙（绒毛间腔）注射无水乙醇（AE）靶向绒毛膜绒毛，该方法甚至可应用于β-人绒毛膜促性腺激素（β-hCG）水平高和/或有胎心搏动的患者。我们在242例异位妊娠患者中检验了该方法的有效性和安全性，其中103例有胎心搏动。定期测量血清β-hCG水平，并进行经阴道超声检查以观察妊娠囊和高回声内环。242例患者中，222例（91.7%）成功治愈。所需AE注射的平均次数为1.6次（范围：1 - 5次），平均剂量为3.2 mL。治疗后，许多患者尝试再次受孕，在145例可追踪的输卵管妊娠患者中，63例（43.4%）成功受孕并分娩，且未观察到副作用；在12例可追踪的宫颈或剖宫产瘢痕妊娠患者中，7例（58.3%）成功受孕并分娩。因此，该方法可能是异位妊娠的一种有效治疗方法，有潜力取代传统的手术干预和使用甲氨蝶呤的药物治疗。
