腹腔镜下单侧输卵管开窗取胚术联合系膜注射甲氨蝶呤治疗输卵管妊娠的临床研究

Efficacy of laparoscopic unilateral salpingostomy combined with mesosalpinx injection of methotrexate in the treatment of tubal pregnancy

摘要:

目的 评价腹腔镜下单侧输卵管开窗取胚术联合系膜注射甲氨蝶呤（MTX）治疗输卵管妊娠的效果，并探讨其对术后恢复和长期妊娠结果的影响。方法 选取2019年3月—2024年3月在中国人民解放军联勤保障部队第九〇四医院及无锡市虹桥医院接受治疗的98例输卵管妊娠患者，将患者随机分为对照组（接受腹腔镜下单侧输卵管开窗取胚术）和试验组（接受腹腔镜下单侧输卵管开窗取胚术联合系膜注射MTX），每组49例。比较两组术后恢复状况［包块消失时间、血清β人绒毛膜促性腺激素（β-hCG）水平恢复正常时间、月经恢复正常时间、住院时间］、β-hCG水平、输卵管通畅状况、血清水平［血管内皮生长因子（VEGF）、胰岛素样生长因子-1（IGF-1）、胰岛素样生长因子结合蛋白-3（IGFBP-3）］、卵巢功能［促黄体生成素（LH）、抗苗勒管激素（AMH）、卵泡刺激素（FSH）、窦状卵泡数（AFC）］、妊娠状况的差异。结果 试验组包块消失时间、β-hCG水平恢复正常时间、月经恢复正常时间和住院时间均短于对照组（P <0.05）。试验组术后3、7 d血清β-hCG下降率均低于对照组（P <0.05）。试验组输卵管通畅状况优于对照组（P <0.016）。试验组术后7 d血清VEGF、IGF-1、IGFBP-3水平均低于对照组（P <0.05）。试验组术前、术后7 d血清VEGF、IGF-1、IGFBP-3的差值均大于对照组（P <0.05）。试验组术后3个月LH、FSH水平均低于对照组，AMH水平、AFC均高于对照组（P <0.05）。试验组术前、术后3个月LH、AMH、FSH、AFC的差值均大于对照组（P <0.05）。试验组宫内妊娠率高于对照组（P <0.05）。结论 腹腔镜下单侧输卵管开窗取胚术联合系膜注射MTX治疗输卵管妊娠不仅能加快术后恢复，降低血清β-hCG水平，提高输卵管通畅率，还可改善远期卵巢功能，提高妊娠率，是一种有效的治疗策略。

Abstract:

Objective To evaluate the efficacy of laparoscopic unilateral salpingostomy combined with mesenteric injection of methotrexate (MTX) in treating tubal pregnancy, and to investigate its impact on postoperative recovery and long-term pregnancy outcomes.Methods Ninety-eight patients with tubal pregnancy treated at our hospitals between March 2019 and March 2024 were enrolled. Patients were randomised in a 1:1 ratio to either the control group (undergoing laparoscopic unilateral salpingostomy) or the experimental group (laparoscopic unilateral salpingostomy combined with mesenteric injection of MTX), with 49 patients in each group. Postoperative recovery between the two groups was compared, including mass resolution time, time to normalization of serum β-human chorionic gonadotropin (β-HCG), time to resumption of normal menstruation, and length of hospital stay. In addition, differences in β-HCG levels, tubal patency, serum biomarkers [vascular endothelial growth factor (VEGF), insulin-like growth factor-1 (IGF-1), and insulin-like growth factor-binding protein-3 (IGFBP-3) ], ovarian function [luteinizing hormone (LH), anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), and antral follicle count (AFC) ], and pregnancy outcomes were evaluated.Results The mass resolution time, time to normalization of β-HCG, time to menstrual recovery, and length of hospital stay were all shorter in the experimental group than in the control group (P < 0.05). The decline rates of serum β-HCG at 3 and 7 days postoperatively were lower in the experimental group than in the control group (P < 0.05). Tubal patency was better in the experimental group than in the control group (P < 0.016). At 7 days postoperatively, serum levels of VEGF, IGF-1, and IGFBP-3 were lower in the experimental group than in the control group (P < 0.05), and the pre- to postoperative changes in these indicators were greater in the experimental group (P < 0.05). At 3 months postoperatively, LH and FSH levels were lower, whereas AMH levels and AFC were higher in the experimental group compared with the control group (P < 0.05). The changes in LH, AMH, FSH, and AFC from preoperative baseline to 3 months postoperatively were greater in the experimental group (P < 0.05). The intrauterine pregnancy rate was higher in the experimental group than in the control group (P < 0.05).Conclusion Laparoscopic unilateral salpingostomy combined with mesosalpinx injection of MTX for tubal pregnancy can accelerate postoperative recovery, reduce serum β-HCG levels, and improve tubal patency. It also enhances long-term ovarian function and increases pregnancy rates, representing an effective therapeutic strategy.