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输卵管切开术与输卵管切除术——一项关于输卵管异位妊娠手术治疗后女性生育能力的24个月随访研究比较

[Salpingotomy vs salpingectomy--a comparison of women's fertility after surgical treatment of tubal ectopic pregnancy during a 24-month follow-up study].

作者信息

Kostrzewa Marta, Zyła Monika, Litwińska Ewelina, Kolasa-Zwierzchowska Dorota, Szpakowski Artur, Stachowiak Grzegorz, Szpakowski Marian, Wilczyński Jacek R

机构信息

Klinika Ginekologii i Onkologii Ginekologicznej Instytutu Cendtrum Zdrowia Matki Polki w Łodzi, Polska.

Klinika Perinatologii i Ginekologii Instytutu Cendtrum Zdrawia Matki Polki w Łodzi, Polska.

出版信息

Ginekol Pol. 2013 Dec;84(12):1030-5. doi: 10.17772/gp/1675.

Abstract

INTRODUCTION

Ectopic pregnancy (EP) is usually located in the Fallopian tube and it has a significant adverse effect on womens fertility Three types of EP treatment include: expectant, medical, and surgical radical (salpingectomy) or conservative (salpingotomy) management.

OBJECTIVES

The aim of the study was to compare women's fertility after surgical radical or conservative treatment of tubal ectopic pregnancy

MATERIALS AND METHODS

Out of the 58 patients operated because of tubal EP pregnancy 22 underwent laparoscopic salpingotomy (group 1) and 36 laparoscopic salpingectomy (group 2). EP-related data were obtained from medical documentation (the symptoms, diagnostic tests, EP risk factors, medical reproductive and surgical history clinical status during EP surgery). Follow-up data were collected by means of a telephone interview. The survey included questions focused on women's fertility during a 24-month period following the surgical treatment of EP (conception, subsequent intrauterine pregnancies and ectopic pregnancy).

RESULTS

A 24-month follow-up period revealed that the cumulative intrauterine pregnancy rate was higher in group 1 (salpingotomy) as compared to group 2 (salpingectomy), i.e. 50% vs. 41.5%, respectively. Tubal EP returned in 13.6% cases (group 1) vs. 19.4% (group 2). All submitted results are statistically insignificant.

CONCLUSIONS

Our findings are consistent with the literature which reports a trend of higher odds for intrauterine pregnancy after salpingotomy for surgical treatment of EP as compared to salpingectomy Moreover the risk for recurrent tubal EP is comparable for both methods. Regardless, the decision about the operating range in case of EP always depends on the actual clinical state of the patient.

摘要

引言

异位妊娠(EP)通常发生在输卵管,对女性生育能力有重大不良影响。EP的三种治疗方式包括:期待治疗、药物治疗以及手术根治性(输卵管切除术)或保守性(输卵管切开术)治疗。

目的

本研究旨在比较输卵管异位妊娠手术根治性或保守性治疗后女性的生育能力。

材料与方法

在58例因输卵管EP妊娠而接受手术的患者中,22例行腹腔镜输卵管切开术(第1组),36例行腹腔镜输卵管切除术(第2组)。从医疗记录中获取与EP相关的数据(症状、诊断检查、EP危险因素、医疗生殖和手术史、EP手术期间的临床状况)。通过电话访谈收集随访数据。该调查包括聚焦于EP手术治疗后24个月内女性生育能力的问题(受孕、随后的宫内妊娠和异位妊娠)。

结果

24个月的随访期显示,第1组(输卵管切开术)的累积宫内妊娠率高于第2组(输卵管切除术),分别为50%和41.5%。输卵管EP复发率在第1组为13.6%,第2组为19.4%。所有提交的结果均无统计学意义。

结论

我们的研究结果与文献一致,文献报道与输卵管切除术相比,输卵管切开术治疗EP后宫内妊娠几率更高。此外,两种方法复发性输卵管EP的风险相当。无论如何,EP手术范围的决定始终取决于患者的实际临床状况。

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