Nathorst-Böös Jörgen, Rafik Hamad Rangeen
Karolinska Institute, Department of Woman and Child Health, Division of Obstetrics and Gynecology, c/o Karolinska Hospital, SE-171 76 Stockholm, Sweden.
Acta Obstet Gynecol Scand. 2004 May;83(5):471-5. doi: 10.1111/j.0001-6349.2004.00375.x.
The purpose of this study was to explore the value of preoperative ultrasound and human chorionic gonadotropin (hCG) monitoring to predict the occurrence of residual trophoblastic tissue after laparoscopic conservative surgery for tubal pregnancy.
During the period from January 1998 to December 1999 all 206 women undergoing treatment for ectopic pregnancy at the Karolinska hospital were included in the study. A vaginal ultrasound examination was performed and the ectopic size was measured. Serum-hCG levels were recorded preoperatively, and at days 1-2 and 14-21 after surgery.
A diameter of 8 mm or less was observed in 13 of the 14 patients needing secondary treatment. The risk of second surgery if the finding at the preoperative ultrasound was larger than 8 mm was 1/73 resulting in a negative predictive value of 0.01. A considerable overlap in the hCG levels was found on days 1-2 after surgery between women with and without second surgery.
Using a single cutoff point for hCG seems to be of little value as residual trophoblastic tissue can manifest itself at different times--early or late--during the postoperative period. Women with a small ectopic pregnancy as detected by preoperative vaginal ultrasound are at high risk of developing residual trophoblastic tissue. These patients should be considered by the surgeon and monitored with hCG levels until values decline and become undetectable. Management of patients with slowly but declining values can be conservative. If hCG levels are rising or do not decline, methotrexate (MTX) can be an alternative.
本研究旨在探讨术前超声检查及人绒毛膜促性腺激素（hCG）监测对预测输卵管妊娠腹腔镜保守手术后滋养细胞残留组织发生情况的价值。
1998年1月至1999年12月期间，卡罗林斯卡医院所有206例接受异位妊娠治疗的女性纳入本研究。进行阴道超声检查并测量异位妊娠包块大小。记录术前、术后第1 - 2天及14 - 21天的血清hCG水平。
14例需要二次治疗的患者中，13例观察到包块直径8mm或更小。如果术前超声检查发现包块大于8mm，二次手术的风险为1/73，阴性预测值为0.01。术后第1 - 2天，有二次手术和无二次手术的女性hCG水平存在相当大的重叠。
由于滋养细胞残留组织可在术后早期或晚期不同时间出现，采用单一hCG临界值似乎价值不大。术前经阴道超声检查发现异位妊娠包块较小的女性发生滋养细胞残留组织的风险较高。外科医生应考虑这些患者，并监测hCG水平，直至其值下降并无法检测到。对于hCG值缓慢下降的患者，管理可较为保守。如果hCG水平上升或未下降，甲氨蝶呤（MTX）可作为一种选择。
