Persistent ectopic pregnancy

　　With the increasing number of conservative surgical treatments for ectopic pregnancy in recent years, laparoscopic surgery, as a safe and effective method for treating ectopic pregnancy, has been widely used in clinical practice. Therefore, new surgical complications have emerged, namely 'persistent ectopic pregnancy'. It is reported that the incidence of persistent ectopic pregnancy is 5% to 20% after laparoscopic surgery. If diagnosis and treatment are not timely in clinical practice, it may threaten the patient's life.
　　The main influencing factors include the following 5 aspects: ① The gestational age is less than 6 weeks or more than 8 weeks. ② Conservative surgery. ③ Cornual pregnancy, interstitial pregnancy. ④ No villi in the postoperative pathology. ⑤ Preoperative β-HCG>3000mIU/ml and/or postoperative β-HCG decrease by less than 55%.

　　In addition to its clinical manifestations, persistent ectopic pregnancy can also cause other diseases. The main complications of this disease include the following:

　　1. Sudden abdominal pain, often accompanied by diarrhea.

　　2. Irregular vaginal bleeding, and massive bleeding can cause hemorrhagic shock.

　　Persistent ectopic pregnancy refers to the condition where trophoblasts survive after conservative surgery or drug treatment for ectopic pregnancy, and human chorionic gonadotropin (HCG) remains at a certain level without decreasing or even increasing. The surviving trophoblasts can still destroy surrounding tissues, causing intra-abdominal hemorrhage. It is a new complication that has emerged after the increase in conservative treatment of tubal pregnancy in recent years. The main manifestation is lower abdominal pain after conservative surgery, occasionally with continued bleeding in the abdominal cavity, amenorrhea, abdominal pain, vaginal bleeding, and pelvic mass.

　　The main manifestation is lower abdominal pain after conservative surgery, occasionally with continued bleeding in the abdominal cavity. Symptoms include abdominal pain, amenorrhea, vaginal bleeding, and pelvic mass.

　　1. The blood HCG level increases after conservative surgery, or there is continuous growth of trophoblasts in the ipsilateral fallopian tube, leading to reoperation or drug treatment.

　　2. Postoperative blood HCG level increases or decreases twice within 3 days

　　3. The symptoms and signs of ectopic pregnancy exist, and severe cases may show internal hemorrhage.

　　If patients who undergo conservative surgery have abdominal pain or intra-abdominal hemorrhage, they should be more vigilant about the occurrence of persistent tubal pregnancy.

　　In order to better prevent persistent ectopic pregnancy and alleviate the postoperative pain of patients, methotrexate (MTX) was used as an adjuvant drug for the preventive treatment of PEP, with significant clinical efficacy. The following is reported.

　　Objective: To analyze and study the clinical efficacy of methotrexate in preventing persistent ectopic pregnancy.

　　Method: A total of 204 patients who underwent laparoscopic conservative surgical treatment were randomly divided into Group A and Group B, each with 102 cases. Group A was treated with methotrexate 10 mg, and Group B was treated with methotrexate 20 mg, both were injected into the residual cavity for treatment. The preventive effect of methotrexate on the incidence of persistent ectopic pregnancy was statistically analyzed.

　　Results: Among 204 patients, 5 (2.45%) had persistent ectopic pregnancy. Among them, 3 cases in Group A (2.94%); 2 cases in Group B (1.96%), and there was no significant difference in the two groups (P>0.05). The incidence rate of adverse reactions was 2.45%, among which 4 cases in Group A (3.92%) and 1 case in Group B (0.98%), and there was a significant difference between the two groups (P<0.05); 12 days after surgery, the decrease rate of β-HCG in non-PEP patients in Group B was significantly different from that in Group A (P

　　Conclusion: Injection of MTX at the residual cavity of the lesion can effectively prevent the occurrence of PEP, significantly and quickly reduce serum β-HCG levels, with fewer adverse reactions, shorten hospital stay, and thus reduce the possibility of secondary surgery, which is worthy of promotion in clinical practice.

　　Monitoring of blood β-HCG is the basis for diagnosing persistent ectopic pregnancy. After conservative salpingectomy, blood β-HCG should be immediately measured as the initial value, and then measured 2-3 times a week until

　　1. First, ensure the supply of high-quality protein, sufficient vitamins and inorganic salts, especially sufficient iron to prevent anemia. Food selection should not only be nutritious but also easy to digest and absorb. Fresh fish, tender chicken, eggs, animal liver, animal blood, lean meat, soy products, milk, jujube, lotus seeds, fresh fruits, and vegetables can be provided.

　　2. Avoid or eat less greasy, cold, and raw foods. It is not advisable to eat radishes, hawthorns, balsam pear, tangerines, and other foods with properties of promoting Qi, activating blood, and being cold. It is recommended to eat more easily digestible foods.

　　3. The time for nourishment should be about half a month, and for those with weak bodies, poor constitution, and excessive blood loss, the nourishment time can be appropriately extended.

　　One, laparotomy, to perform salpingectomy or another conservative operation;

　　Two, salpingectomy or another conservative operation under laparoscopy;

　　Three, conservative treatment with MIX or other drugs; four, continue to use continuous observation conservative methods.