Fujishita Akira, Khan Khaleque Newaz, Kitajima Michio, Hiraki Koichi, Miura Seiyou, Ishimaru Tadayuki, Masuzaki Hideaki
Department of Obstetrics and Gynecology, Nagasaki University School of Medicine, Nagasaki, Japan.
Eur J Obstet Gynecol Reprod Biol. 2008 Apr;137(2):210-6. doi: 10.1016/j.ejogrb.2007.01.016. Epub 2007 Apr 24.
We investigated the outcome of laparoscopic salpingotomy for tubal pregnancy by follow-up hysterosalpingography (HSG) or second-look laparoscopy (SLL) and reexamined the indication for and limitation of this conservative surgery.
From April 1991 to December 2003, we treated 181 cases of tubal pregnancy using laparoscopic salpingotomy. The tubal patency was assessed by either HSG or SLL performed at 3 months post-surgery. The patients with a successful initial operation and confirmed ipsilateral patent tubes at follow-up were classified as truly successful cases (group I). Even after successful operation, if the treated tubes were found to be occluded, they were considered as unsuccessful cases. Therefore, those cases that were unsuccessful at initial surgery as well as at follow-up were categorized as group II.
One hundred and thirty-four cases (74%) were successfully treated by salpingotomy at initial laparoscopy and 85 of them (63.4%) were found to be truly successful at follow-up (group I). The remaining 47 cases (26.0%) were unsuccessful at initial surgery and 18 (13.4%) cases at follow-up (group II). Thirty-one other patients refused to accept a tubal patency test or were not examined for personal reasons or were lost to follow-up. No difference in surgical outcome was observed between these two groups of patients with regard to gestational age, intra-operative hemorrhage, size or anatomic location of the pregnancy mass, and pre-operative adhesions of the fallopian tube. However, pre-operative serum levels of hCG were significantly higher in group II than in group I. In addition, the unsuccessful cases were more frequently associated with positive fetal heart beat (FHB), tubal rupture, and pre-operative serum levels of hCG of more than 10,000 IU/l (p<0.05, chi2 test). The log-rank test indicated a higher pregnancy success rate in group I (p<0.05) than in group II in those who desired future pregnancy.
Laparoscopic salpingotomy may be practised as conservative surgery for proximal ectopic pregnancy, and gestational mass size is not as important and is not a relative contraindication for conservative laparoscopic surgery, as previously reported. Low pre-operative HCG levels, absence of FHB, absence of tubal rupture initially or minimal rupture may be considered suitable parameters for successful surgery and for achieving future pregnancy.
我们通过随访子宫输卵管造影术（HSG）或二次腹腔镜检查（SLL）来研究腹腔镜输卵管切开术治疗输卵管妊娠的结局，并重新审视这种保守手术的适应证和局限性。
从1991年4月至2003年12月，我们采用腹腔镜输卵管切开术治疗了181例输卵管妊娠患者。术后3个月通过HSG或SLL评估输卵管通畅情况。初始手术成功且随访时同侧输卵管通畅得到确认的患者被归类为真正成功的病例（I组）。即使手术成功，如果发现治疗的输卵管阻塞，则将其视为不成功的病例。因此，那些初始手术和随访均不成功的病例被归类为II组。
134例（74%）患者在初次腹腔镜检查时通过输卵管切开术成功治疗，其中85例（63.4%）在随访时被发现真正成功（I组）。其余47例（26.0%）在初始手术时不成功，18例（13.4%）在随访时不成功（II组）。另外31例患者拒绝接受输卵管通畅性检查，或因个人原因未接受检查，或失访。在这两组患者之间，手术结局在孕周、术中出血、妊娠包块大小或解剖位置以及输卵管术前粘连方面未观察到差异。然而，II组术前血清hCG水平显著高于I组。此外，不成功的病例更常伴有胎心搏动（FHB）阳性、输卵管破裂以及术前血清hCG水平超过10,000 IU/l（p<0.05，卡方检验）。对数秩检验表明，在期望未来怀孕的患者中，I组的妊娠成功率高于II组（p<0.05）。
腹腔镜输卵管切开术可作为近端异位妊娠的保守手术，且妊娠包块大小并不像先前报道的那样重要，也不是保守性腹腔镜手术的相对禁忌证。术前hCG水平低、无胎心搏动、初始时无输卵管破裂或仅有轻微破裂可被视为手术成功及实现未来妊娠的合适参数。
