Pandian Zabeena, Akande Valentine A, Harrild Kirsten, Bhattacharya Siladitya
Obstetrics & Gynaecology, Aberdeen Maternity Hospital, Foresterhill, Aberdeen, UK, AB25 2ZD.
Cochrane Database Syst Rev. 2008 Jul 16(3):CD006415. doi: 10.1002/14651858.CD006415.pub2.
Tubal surgery is a widely accepted treatment for tubal infertility. Estimated livebirth rates after surgery range from 9% for women with severe tubal disease to 69% for those with mild disease, however, its effectiveness has not been rigorously evaluated in comparison with other treatments such as in vitro fertilisation (IVF) and expectant management (no treatment). Livebirth rates have not been adequately assessed in relation to the severity of tubal damage. It is important to determine the effectiveness of surgery against other treatment options in women with tubal infertility because of concerns about adverse outcomes, intra-operative complications and the costs associated with tubal surgery.
The aim of this review was to determine whether surgery improves the probability of livebirth compared with expectant management or IVF in the context of tubal infertility (regardless of grade of severity).
We searched the Cochrane Menstrual Disorders and Subfertility Group's trials register (searched August 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue, 2007), MEDLINE (1970 to August 2007), EMBASE (1985 to August 2007) and reference lists of articles. We also handsearched relevant conference proceedings and contacted researchers in the field.
Only randomised controlled trials were considered eligible, with livebirth rate per woman as the primary outcome of interest.
Two review authors independently assessed eligibility and quality of trials.
No suitable randomised controlled trials were identified.
AUTHORS' CONCLUSIONS: Any effect of tubal surgery relative to expectant management and IVF in terms of livebirth rates for women with tubal infertility remains unknown. Large trials with adequate power are warranted to establish the effectiveness of surgery in these women. Future trials should not only report livebirth rates per woman, but also compare adverse effects and costs of the treatments as outcomes. Factors that have a major effect on these outcomes, such as fertility treatment, female partner's age, duration of infertility, and previous pregnancy history should be considered. Livebirth rates in relation to the severity of tubal damage, and different techniques used for tubal repair including microsurgery and laparoscopic methods should also be reported.
输卵管手术是治疗输卵管性不孕广泛接受的一种方法。手术后的估计活产率从患有严重输卵管疾病的女性的9%到患有轻度疾病的女性的69%不等，然而，与其他治疗方法如体外受精（IVF）和期待治疗（不治疗）相比，其有效性尚未得到严格评估。活产率尚未根据输卵管损伤的严重程度进行充分评估。由于担心不良结局、术中并发症以及与输卵管手术相关的费用，确定输卵管性不孕女性手术相对于其他治疗选择的有效性很重要。
本综述的目的是确定在输卵管性不孕（无论严重程度如何）的情况下，与期待治疗或IVF相比，手术是否能提高活产概率。
我们检索了Cochrane月经紊乱和生育力低下小组的试验注册库（2007年8月检索）、Cochrane对照试验中央注册库（Cochrane图书馆2007年第期）、MEDLINE（1970年至2007年8月）、EMBASE（1985年至2007年8月）以及文章的参考文献列表。我们还手工检索了相关会议记录并联系了该领域的研究人员。
仅考虑随机对照试验符合条件，将每位女性的活产率作为主要关注结局。
两位综述作者独立评估试验的合格性和质量。
未识别出合适的随机对照试验。
输卵管手术相对于期待治疗和IVF对输卵管性不孕女性活产率的任何影响仍然未知。有必要进行有足够效力的大型试验来确定手术对这些女性的有效性。未来的试验不仅应报告每位女性的活产率，还应比较治疗的不良反应和费用作为结局。应考虑对这些结局有重大影响的因素，如生育治疗、女性伴侣年龄、不孕持续时间和既往妊娠史。还应报告与输卵管损伤严重程度相关的活产率，以及用于输卵管修复的不同技术，包括显微手术和腹腔镜方法。
