Huang Xiaoyan, Li Juan, Wu Yurui, Wang Jidong
Department of Obstetric and Gynecology, Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan 250014, China.
Department of Obstetric and Gynecology, Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan 250014, China.
Int J Surg Case Rep. 2025 Mar;128:111057. doi: 10.1016/j.ijscr.2025.111057. Epub 2025 Feb 13.
Abdominal ectopic pregnancies(APs) is a rare type of ectopic pregnancy, most commonly implanting in the rectouterine pouch. The treatment methods include surgical treatment and drug therapy. In the surgical treatment of ectopic pregnancy, local injection of methotrexate(MTX)at the site of pregnancy can reduce the occurrence of persistent ectopic pregnancy(PEP). However, there is no unified standard for the treatment dosage. We report a case of an AP patient who received local injection of MTX during surgery and developed neutropenia postoperatively.
A 29-year-old woman with a 45-day history of missed menses and rectal pressure presented with suspected ruptured ectopic pregnancy. Intraoperative exploration revealed no abnormalities in the appearance of both ovaries and fallopian tubes. Upon careful examination, the pregnancy tissue was found to be located on the inner side of the right sacral ligament and the pregnancy tissue was removed. To prevent the occurrence of PEP, MTX was locally injected at a dose of 50 mg/m during the surgery. Postoperatively, the patient developed leukopenia, with a white blood cell (WBC) count of 3.22 × 10/L on day 4, which further decreased to 2.59 × 10/L with a neutrophil (NEUT)count of 1.19 × 10/L by day 10. The patient was treated with Di Yu Sheng Bai tablets, 3 tablets orally three times a day. On the 17th postoperative day, the WBC count was 3.1 × 10/L and the absolute neutrophil(NEUT) count was 1.21 × 10/L. The patient received recombinant human granulocyte colony-stimulating factor (G-CSF) at a dose of 200 μg for three days. Granulocytes returned to normal levels.
APs is a rare form of ectopic pregnancy that can be treated with laparoscopy in the early stages of pregnancy. It is well known that local injection of MTX at the site of pregnancy during surgery can reduce the occurrence of PEP. There are documented cases of local MTX injection reducing the occurrence of PEP in special locations such as retroperitoneal pregnancy and cervical pregnancy. However, there is no unified standard for the therapeutic dosage. The minimum effective dose of locally injected MTX to prevent PEP needs further exploration. There have been no reports on the occurrence of granulocytopenia due to the local injection of MTX during surgery for ectopic pregnancy to prevent the PEP.
Ectopic pregnancy patients, such as those with abdominal pregnancy, if treated with a combination of local MTX injection during surgery, require close postoperative monitoring of blood routine. The minimum effective dose still needs further exploration.
腹腔异位妊娠是一种罕见的异位妊娠类型，最常见于直肠子宫陷凹着床。治疗方法包括手术治疗和药物治疗。在异位妊娠的手术治疗中，于妊娠部位局部注射甲氨蝶呤（MTX）可减少持续性异位妊娠（PEP）的发生。然而，治疗剂量尚无统一标准。我们报告一例腹腔异位妊娠患者，其在手术中接受了MTX局部注射，术后出现了中性粒细胞减少。
一名29岁女性，停经45天，伴有直肠坠胀感，因疑似异位妊娠破裂就诊。术中探查发现双侧卵巢及输卵管外观无异常。仔细检查后，发现妊娠组织位于右侧骶韧带内侧，遂将妊娠组织移除。为预防PEP的发生，术中以50mg/m²的剂量局部注射MTX。术后，患者出现白细胞减少，术后第4天白细胞（WBC）计数为3.22×10⁹/L，至第10天进一步降至2.59×10⁹/L，中性粒细胞（NEUT）计数为1.19×10⁹/L。患者口服地榆升白片治疗，每日3次，每次3片。术后第17天，WBC计数为3.1×10⁹/L，绝对中性粒细胞（NEUT）计数为1.21×10⁹/L。患者接受了3天剂量为200μg的重组人粒细胞集落刺激因子（G-CSF）治疗。粒细胞恢复至正常水平。
腹腔异位妊娠是一种罕见的异位妊娠形式，在妊娠早期可通过腹腔镜进行治疗。众所周知，手术中于妊娠部位局部注射MTX可减少PEP的发生。有文献记载在腹膜后妊娠和宫颈妊娠等特殊部位局部注射MTX可减少PEP的发生。然而，治疗剂量尚无统一标准。局部注射MTX预防PEP的最低有效剂量有待进一步探索。尚无关于异位妊娠手术中为预防PEP局部注射MTX导致粒细胞减少的报道。
异位妊娠患者，如腹腔妊娠患者，若在手术中联合局部注射MTX治疗，术后需密切监测血常规。最低有效剂量仍需进一步探索。
