Bouyer J, Job-Spira N, Pouly J L, Coste J, Germain E, Fernandez H
INSERM U292, Bicêtre Hospital, Le Kremlin-Bicêtre, France.
BJOG. 2000 Jun;107(6):714-21. doi: 10.1111/j.1471-0528.2000.tb13330.x.
To investigate the factors influencing the choice of treatment for ectopic pregnancy and to compare the subsequent fertility rates of radical, conservative-surgical or medical treatments.
Population-based study of 835 ectopic pregnancies registered between 1992 and 1996.
Auvergne Ectopic Pregnancy Register (France).
Four hundred and seventy-six women with tubal ectopic pregnancy who were not using contraception at the time of conception. Subsequent fertility was studied for the 291 women who attempted to conceive again.
Comparison of reproductive outcomes according to ectopic pregnancy treatment. Cumulative fertility curves were calculated by the Kaplan-Meier estimator and compared by log rank test for univariate analysis and by Cox regression to take into account confounding variables.
Recurrence and fertility rates after ectopic pregnancy.
The first treatment given was 'radical' for 178 women (37%), 'conservative-surgical' for 262 (55%), and 'medical' for 35 (8%). The treatment failed in 1% for radical treatment, 5% for conservative-surgical treatment, and 36% for medical treatment. The two-year cumulative rate of recurrence was 27% with no significant difference between treatments. For women with previous infertility factors (in particular diseased contralateral tube), the treatments differed significantly, with the rate of intrauterine pregnancy lower for radical treatment and higher for medical treatment than for conservative-surgical treatment. For women with no infertility factor, there was no significant difference between treatments.
These results should be confirmed in a controlled trial. The results of this study provide the elements necessary to plan such a trial.
研究影响异位妊娠治疗方式选择的因素，并比较根治性手术、保守性手术或药物治疗后的后续生育率。
基于人群的研究，纳入1992年至1996年间登记的835例异位妊娠病例。
奥弗涅异位妊娠登记处（法国）。
476例输卵管异位妊娠妇女，她们在受孕时未采取避孕措施。对291例试图再次受孕的妇女的后续生育情况进行了研究。
根据异位妊娠治疗方式比较生殖结局。采用Kaplan-Meier估计量计算累积生育曲线，并通过对数秩检验进行单因素分析比较，通过Cox回归分析考虑混杂变量。
异位妊娠后的复发率和生育率。
首次治疗采用“根治性”手术的有178例妇女（37%），“保守性手术”的有262例（55%），“药物”治疗的有35例（8%）。根治性治疗失败率为1%，保守性手术治疗为5%，药物治疗为36%。两年累积复发率为27%，不同治疗方式之间无显著差异。对于既往有不孕因素（特别是对侧输卵管患病）的妇女，治疗方式有显著差异，根治性治疗的宫内妊娠率低于保守性手术治疗，药物治疗的宫内妊娠率高于保守性手术治疗。对于无不孕因素的妇女，不同治疗方式之间无显著差异。
这些结果应在对照试验中得到证实。本研究结果为规划此类试验提供了必要的依据。
