Pouly J L, Chapron C, Manhes H, Canis M, Wattiez A, Bruhat M A
Département de Gynécologie Obstétrique et Reproduction Humaine, Polyclinique Philippe Marcombe, Centre Hospitalier Universitaire, Clermont-Ferrand, France.
Fertil Steril. 1991 Sep;56(3):453-60. doi: 10.1016/s0015-0282(16)54539-7.
To lay down the criteria to clearly define whether conservative or radical laparoscopic treatment should be adopted in cases of ectopic pregnancies (EP).
Retrospective, noncomparative.
At the University Hospital of Clermont Ferrand and the La Pergola Clinic at Vichy from July 1974 to December 1987.
This study was carried out in 223 patients who had been treated laparoscopically for EP and who desired future childbearing and who were not lost to follow-up.
The measures chosen to achieve the objective included age, parity, size of hematosalpinx, volume of hemoperitoneum, tubal rupture, location, intrauterine device, ipsilateral and contralateral adhesions, and patient's previous history of salpingitis, EP, solitary tube, and tubal infertility.
The general intrauterine pregnancy rate was 67% (149 patients) and the recurrence rate 12% (27 patients). The results according to the studied factors demonstrated that age, parity, and the type of the EP have no influence on the postectopic fertility. The history of the patient, ipsilateral adhesions, or contralateral tubal status significantly reduce the future fertility prognosis and risk of recurrence.
From a multivariable analysis, the authors propose a scoring system to choose the most suitable treatment to preserve fertility and to reduce the risk of recurrence ranging from laparoscopic conservative treatment to laparoscopic salpingectomy with contralateral sterilization.
制定标准，以明确在异位妊娠（EP）病例中应采用保守性还是根治性腹腔镜治疗。
回顾性、非对比性研究。
1974年7月至1987年12月期间，在克莱蒙费朗大学医院和维希的拉佩尔戈拉诊所。
本研究纳入了223例接受腹腔镜治疗的EP患者，这些患者希望未来生育且未失访。
为实现该目标所选择的指标包括年龄、产次、输卵管积血大小、腹腔积血量、输卵管破裂、位置、宫内节育器、同侧和对侧粘连，以及患者既往的输卵管炎、EP、单输卵管和输卵管性不孕病史。
总体宫内妊娠率为67%（149例患者），复发率为12%（27例患者）。根据研究因素得出的结果表明，年龄、产次和EP类型对异位妊娠后的生育能力没有影响。患者的病史、同侧粘连或对侧输卵管状况会显著降低未来的生育预后和复发风险。
通过多变量分析，作者提出了一种评分系统，以选择最合适的治疗方法，以保留生育能力并降低复发风险，范围从腹腔镜保守治疗到腹腔镜输卵管切除术并对侧绝育。
