Barnhart K, Spandorfer S, Coutifaris C
Department of Obstetrics and Gynecology, University of Pennsylvania Medical Center, Philadelphia 19104, USA.
J Reprod Med. 1997 Aug;42(8):521-4.
Medical management of ectopic pregnancy is effective in selected cases and is recommended to treat interstitial pregnancy to avoid surgery that may limit future fertility. Although successful medical management of interstitial pregnancy has been reported, evidence does not support success rates equal to that in other ectopic locations.
Four cases of interstitial ectopic pregnancy were identified. Only one of the four was successfully treated with medical therapy. Case 1 was a confirmed, 2.5-cm interstitial pregnancy that failed a multiple-dose methotrexate protocol. Case 2 was an unrecognized interstitial pregnancy that failed single-dose therapy. Case 3 was a rupture of a medically managed interstitial pregnancy despite complete resolution of serum human chorionic gonadotropin. A literature review demonstrated an overall combined failure rate of 35% (7/20).
Compared with an isthmic or ampullary pregnancy, a disproportionate number of patients with interstitial pregnancy fail medical management and require emergency surgery. The presence of a documented interstitial pregnancy is not an absolute contraindication to medical management. Patients should be counseled that medical management of an interstitial pregnancy may not have the same rate of success as it does in other locations in the fallopian tube. Surgery in this case may be the preferred treatment option.
异位妊娠的药物治疗在特定病例中是有效的，并且推荐用于治疗间质部妊娠，以避免可能限制未来生育能力的手术。虽然已有间质部妊娠药物治疗成功的报道，但证据并不支持其成功率与其他异位部位相同。
确定了4例间质部异位妊娠病例。4例中仅1例药物治疗成功。病例1为确诊的2.5厘米间质部妊娠，多剂量甲氨蝶呤方案治疗失败。病例2为未识别的间质部妊娠，单剂量治疗失败。病例3为间质部妊娠药物治疗期间发生破裂，尽管血清人绒毛膜促性腺激素已完全消退。文献综述显示总体联合失败率为35%（7/20）。
与峡部或壶腹部妊娠相比，间质部妊娠失败并需要急诊手术的患者比例过高。间质部妊娠的记录存在并非药物治疗的绝对禁忌证。应告知患者，间质部妊娠的药物治疗成功率可能与输卵管其他部位不同。在此情况下，手术可能是首选的治疗选择。
