Song Taejong, Lee Dong Hee, Kim Hwa Cheung, Seong Seok Ju
Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.; Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea.
Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Obstet Gynecol Sci. 2016 Nov;59(6):512-518. doi: 10.5468/ogs.2016.59.6.512. Epub 2016 Nov 15.
To present our experience with laparoscopic tube-preserving surgery for ectopic tubal pregnancy and evaluate its feasibility and efficacy.
This was a prospective study of 57 consecutive patients with ectopic tubal pregnancies undergoing laparoscopic tube-preserving procedures including salpingotomy, salpingostomy, segmental resection and reanastomosis, and fimbrial milking. The outcome measures were treatment success rates and homolateral patency rates.
Of the 57 surgical procedures, 55 (96.4%) were performed successfully without any additional intervention. The number of patients receiving salpingotomy, salpingostomy, segmental resection and reanastomosis, and fimbrial milking were 24 (42.1%), 25 (43.9%), 4 (7.0%), and 2 (3.5%), respectively. Two case was switched to salpingectomy because excessive bipolar coagulation was required to obtain hemostasis at the tubal bleeding bed. Over a mean β-human chorionic gonadotropin resolution time of 18.3±5.9 days, no persistent trophoblast or postoperative complications occurred. A tubal patency test using hysterosalpingography was performed in 15 cases at 3 months postoperatively. Among these, the homolateral tubal patency rate was 75% (11 of 15) and the contralateral patency rate was 80% (12 of 15).
Tube-preserving surgery is a feasible and safe treatment option for ectopic tubal pregnancy. However, considering that the optimal goal of tube-preserving surgical procedures is not the treatment success, some caution is warranted in interpreting results of this study.
介绍我们对输卵管妊娠行腹腔镜保留输卵管手术的经验，并评估其可行性和疗效。
这是一项前瞻性研究，连续纳入57例接受腹腔镜保留输卵管手术的输卵管妊娠患者，手术方式包括输卵管切开术、输卵管造口术、节段性切除及再吻合术和伞端挤压术。观察指标为治疗成功率和同侧输卵管通畅率。
57例手术中，55例（96.4%）成功完成，无需额外干预。接受输卵管切开术、输卵管造口术、节段性切除及再吻合术和伞端挤压术的患者分别为24例（42.1%）、25例（43.9%）、4例（7.0%）和2例（3.5%）。2例因输卵管出血部位需过多双极电凝止血而改行输卵管切除术。β-人绒毛膜促性腺激素平均消退时间为18.3±5.9天，未发生持续性滋养细胞残留或术后并发症。术后3个月对15例患者行子宫输卵管造影检查输卵管通畅情况。其中，同侧输卵管通畅率为75%（15例中的11例），对侧通畅率为80%（15例中的12例）。
保留输卵管手术是治疗输卵管妊娠的一种可行且安全的选择。然而，鉴于保留输卵管手术的最佳目标并非治疗成功，在解读本研究结果时应谨慎。
