Gross Z, Rodriguez J J, Stalnaker B L
Department of Obstetrics and Gynecology, University of Florida College of Medicine/Pensacola, USA.
J Reprod Med. 1995 May;40(5):371-4.
Seventeen patients with suspected ectopic pregnancy (EP) were managed as outpatients with single-dose intramuscular methotrexate (MTX) in a community hospital. A nonsurgical method was utilized for evaluation based on transvaginal ultrasonography in combination with serum human chorionic gonadotropin (hCG) determination and performance of dilation and curettage (D&C). The mean pretreatment hCG concentration was 3,320.9 mIU/mL, with a range of 158-12,420. Sixteen of 17 (94.1%) patients responded successfully to therapy, with a mean duration until hCG resolution of 26.4 days (range, 12-55). One patient experienced rupture 14 days after treatment. One of 17 patients (5.9%) complained of increased abdominal pain six days after treatment and was managed without intervention. There were no reports of adverse effects from the chemotherapy. This study demonstrated that nonsurgical evaluation for presumed EP in carefully selected patients may be performed without D&C and managed safely and effectively with well-tolerated, single-dose, systemic MTX. Our approach was designed for community hospitals.
在一家社区医院，17例疑似异位妊娠（EP）患者作为门诊患者接受了单剂量肌内注射甲氨蝶呤（MTX）治疗。采用非手术方法，基于经阴道超声检查结合血清人绒毛膜促性腺激素（hCG）测定以及刮宫术（D&C）进行评估。治疗前hCG的平均浓度为3320.9 mIU/mL，范围为158 - 12420。17例患者中有16例（94.1%）治疗成功，hCG降至正常的平均持续时间为26.4天（范围为12 - 55天）。1例患者在治疗后14天发生破裂。17例患者中有1例（5.9%）在治疗后6天出现腹痛加重，未进行干预处理。未报告化疗的不良反应。本研究表明，对于精心挑选的疑似EP患者，可不进行刮宫术进行非手术评估，并使用耐受性良好的单剂量全身MTX安全有效地进行治疗。我们的方法是为社区医院设计的。
