Women's University Hospital, Tübingen University, Calwerstrasse 7, Tübingen, Germany.
Arch Gynecol Obstet. 2011 Jan;283(1):41-5. doi: 10.1007/s00404-009-1270-2. Epub 2009 Nov 10.
With most ectopic pregnancy (EP) cases now diagnosed and treated early, a major concern has become future reproductive outcome. The aim of this study was to evaluate long-term reproductive outcome after salpingotomy versus salpingectomy in patients with and without additional fertility-reducing factors.
As part of a prospective follow-up study, 261 patients underwent laparoscopic management of EP at our institution. History was taken specifically looking at preexisting risk factors for reduced fertility. Patients were then followed with regard to future reproductive events.
Of 261 patients, 196 (75%) reported a subsequent desire for pregnancy. 145 patients had undergone salpingotomy and 51 salpingectomy. In patients without prior history of fertility-reducing factors, the subsequent intrauterine pregnancy rates were >90% for both salpingotomy and salpingectomy groups irrespective of the surgical approach. In patients with preexisting fertility-reducing factors, postoperative intrauterine pregnancy rates were 75% in the salpingotomy group, but only 40% in the salpingectomy group (p < 0.05), showing maximal effect for conservative surgery.
Laparoscopic salpingotomy is of particular benefit for patients with additional fertility-reducing factors desirous of future pregnancy. Reproductive outcome is excellent in patients without such risk factor, irrespective of the surgical approach.
随着大多数异位妊娠（EP）病例的早期诊断和治疗，人们主要关注的是未来的生殖结局。本研究旨在评估有或无其他降低生育能力因素的患者行输卵管切开术与输卵管切除术的长期生殖结局。
作为前瞻性随访研究的一部分，我院对 261 例 EP 患者进行了腹腔镜治疗。专门采集病史以了解是否存在降低生育能力的既往风险因素。然后，患者的未来生殖事件进行了随访。
261 例患者中，196 例（75%）报告有后续妊娠需求。145 例行输卵管切开术，51 例行输卵管切除术。在无既往降低生育能力因素的患者中，无论手术方式如何，输卵管切开术和输卵管切除术组的术后宫内妊娠率均>90%。在存在降低生育能力的既往因素的患者中，输卵管切开术组的术后宫内妊娠率为 75%，而输卵管切除术组仅为 40%（p<0.05），表明保守手术效果最佳。
对于有进一步生育能力降低因素且希望未来妊娠的患者，腹腔镜输卵管切开术特别有益。无此类风险因素的患者，无论手术方式如何，生殖结局均良好。
