Slaughter J L, Grimes D A
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, School of Medicine, USA.
West J Med. 1995 Mar;162(3):225-8.
Ectopic pregnancy has become a surgical epidemic over the past two decades. To minimize the morbidity, mortality, and financial burden created by this rapidly growing health problem, nonsurgical alternatives have been investigated, including treatment with methotrexate. We reviewed current literature to evaluate the safety, efficacy, and costs associated with methotrexate treatment of tubal pregnancy. To date, 17 studies have reported on 400 patients with tubal pregnancies treated with parenteral methotrexate; the overall success rate was 92% (95% confidence interval, 89% to 95%). Single-dose parenteral methotrexate has been shown to be safe, effective, and associated with minimal costs when used in carefully selected patients. A prospective, randomized clinical trial comparing medical and surgical management of ectopic pregnancy is needed to assess the risks, benefits, and costs of these two approaches.
在过去二十年中，异位妊娠已成为一种外科流行病。为了将这一迅速增长的健康问题所造成的发病率、死亡率和经济负担降至最低，人们对非手术替代方案进行了研究，包括使用甲氨蝶呤进行治疗。我们回顾了当前的文献，以评估甲氨蝶呤治疗输卵管妊娠的安全性、有效性和成本。迄今为止，已有17项研究报告了400例接受胃肠外甲氨蝶呤治疗的输卵管妊娠患者；总体成功率为92%（95%置信区间，89%至95%）。单剂量胃肠外甲氨蝶呤已被证明在精心挑选的患者中使用时是安全、有效的，且成本最低。需要进行一项比较异位妊娠药物治疗和手术治疗的前瞻性随机临床试验，以评估这两种方法的风险、益处和成本。
