Fernandez H, Benifla J L, Lelaidier C, Baton C, Frydman R
Department of Gynecology and Obstetrics, Hôpital Antoine Béclère, Clamart, France.
Fertil Steril. 1993 Apr;59(4):773-7. doi: 10.1016/s0015-0282(16)55858-0.
To evaluate safety and efficacy of intrasaccular methotrexate (MTX) for treatment of ectopic pregnancy (EP).
Longitudinal nonrandomized trial of MTX treatment of EP.
Department of Obstetrics and Gynecology (A. Béclère Public Hospital, Clamart, France Paris-Sud University).
One hundred patients with an EP visualized by sonography. Patients were 31.4 +/- 4.8 years old, para 0 to 4, and gravida 0 to 7. Twelve patients had a past history of EP, and 18 had previously undergone tubal surgery. Inclusion score for proposed medical treatment used six criteria graded from 1 to 3: gestational age, initial hCG level, P level, existence of abdominal pain, size of hemoperitoneum, and diameter of hematosalpinx. Eleven patients had an EP with cardiac activity. Treatment consisted of MTX, 1 mg/kg, given locally under transvaginal sonographic control.
Eighty-three of 100 patients were considered to be completely cured (return of hCG to < 10 mIU/mL). The success rate was 92.8% with an initial hCG level < 5,000 mIU/mL and 87% when the score was < or = 12. Seven of the 11 patients with an EP with cardiac activity were treated successfully, including 5 of 7 when the initial score was < or = 12, and all failures concerned cases with an initial score > 12. Twenty-eight of 83 patients treated successfully required more than one injection of MTX (additional doses being given intramuscularly) because of nonresolution of hCG levels. Follow-up hysterosalpingography was performed in 80 patients showing 90% tubal patency on the side of the treated EP. Of 58 patients wishing pregnancy, 34 pregnancies occurred, including 25 ongoing or delivered. We observed a low recurrence rate of EP (3 with 1 on the same side).
Treatment by initial transvaginal injection of MTX under sonographic control appears to be simple and effective, with no demonstrable untoward effects. The tubal patency and subsequent fertility obtained appear satisfactory. The highest success rate is observed when hCG level is under 5,000 mIU/mL and/or a pretherapeutic score < or = 12 when EP is visualized by sonography.
评估囊内注射甲氨蝶呤（MTX）治疗异位妊娠（EP）的安全性和有效性。
MTX治疗EP的纵向非随机试验。
妇产科（法国巴黎南大学克拉马尔A.贝克莱尔公立医院）。
100例经超声检查确诊为EP的患者。患者年龄为31.4±4.8岁，产次0至4次，妊娠次数0至7次。12例患者有EP病史，18例曾接受过输卵管手术。拟采用药物治疗的纳入评分采用6项标准，从1至3级：孕周、初始hCG水平、P水平、腹痛情况、腹腔内积血大小及输卵管积血直径。11例患者的EP有心脏活动。治疗方法为在经阴道超声引导下局部注射MTX，剂量为1mg/kg。
100例患者中有83例被认为完全治愈（hCG恢复至<10mIU/mL）。初始hCG水平<5000mIU/mL时成功率为92.8%，评分≤12分时成功率为87%。11例有心脏活动的EP患者中有7例治疗成功，初始评分≤12分时7例中有5例成功，所有失败病例初始评分均>12分。83例治疗成功的患者中有28例因hCG水平未恢复正常需要多次注射MTX（额外剂量采用肌内注射）。80例患者接受了随访子宫输卵管造影，结果显示治疗侧EP输卵管通畅率为90%。58例希望妊娠的患者中有34例妊娠，其中25例为持续妊娠或已分娩。我们观察到EP复发率较低（3例复发，1例在同一侧）。
在超声引导下经阴道初次注射MTX治疗似乎简单有效，且无明显不良影响。所获得的输卵管通畅率及后续生育能力似乎令人满意。当hCG水平低于5000mIU/mL和/或超声检查发现EP时治疗前评分≤12分时成功率最高。
