Seifer D B, Gutmann J N, Doyle M B, Jones E E, Diamond M P, DeCherney A H
Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut.
Obstet Gynecol. 1990 Dec;76(6):1121-5.
As the surgical approach for ectopic pregnancies evolves from radical to conservative procedures, the potential hazard of persistent ectopic pregnancy has become increasingly pertinent. From September 1, 1986 to August 31, 1989, 11 women with persistent ectopic pregnancy after laparoscopic salpingostomy were diagnosed and treated at Yale-New Haven Hospital. Persistent ectopic pregnancy was suspected in nine cases because of symptoms and in two because of plateauing beta-hCG titers. Ten of 11 patients underwent repeat surgery. Eight had partial or complete salpingectomy of the involved ipsilateral tube, two had repeat salpingostomies, and one was treated with methotrexate. When the 11 women with persistent ectopic pregnancies were compared with 70 patients treated successfully by laparoscopic salpingostomy using multivariate stepwise logistic regression, smaller size of the ectopic (P less than .01) and fewer days of amenorrhea (P less than .05) predicted persistent ectopic pregnancy after laparoscopic salpingostomy. Based upon our experience, we believe that earlier-treated ectopic pregnancies (ie, fewer than 42 days of amenorrhea) and/or smaller ectopics (ie, 2.0 cm or less in diameter) require treatment with particular caution and close postoperative surveillance.
随着异位妊娠的手术方式从根治性手术向保守性手术发展，持续性异位妊娠的潜在风险变得越来越突出。1986年9月1日至1989年8月31日，耶鲁-纽黑文医院诊断并治疗了11例腹腔镜输卵管造口术后发生持续性异位妊娠的患者。9例因症状怀疑持续性异位妊娠，2例因β-hCG水平稳定而怀疑。11例患者中有10例接受了再次手术。8例行患侧输卵管部分或全切除术，2例行再次输卵管造口术，1例接受甲氨蝶呤治疗。采用多因素逐步逻辑回归分析，将11例持续性异位妊娠患者与70例腹腔镜输卵管造口术成功治疗的患者进行比较，结果显示异位妊娠体积较小（P<0.01）和闭经天数较少（P<0.05）是腹腔镜输卵管造口术后持续性异位妊娠的预测因素。根据我们的经验，我们认为早期治疗的异位妊娠（即闭经少于42天）和/或较小的异位妊娠（即直径2.0 cm或更小）需要特别谨慎地治疗并进行密切的术后监测。
