Farahani Linda, Sinha Anjita, Lloyd Jilly, Islam Melissa, Ross Jackie A
Early Pregnancy Unit, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.
Early Pregnancy Unit, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.
Eur J Obstet Gynecol Reprod Biol. 2017 Jun;213:98-101. doi: 10.1016/j.ejogrb.2017.04.001. Epub 2017 Apr 2.
To determine the outcome of histological examinations of surgical specimens obtained from treatment of tubal ectopic pregnancy and to correlate with clinical findings, pre-operative ultrasound scans and the type of surgery.
A retrospective cohort study of 941 women diagnosed with a tubal ectopic pregnancy in the Early Pregnancy Unit and having surgical treatment at King's College Hospital, London. Clinical and ultrasound data had been entered contemporaneously on our electronic early pregnancy database and hospital clinical records over an 11year period from 2004 to 2014. Demographic data, clinical history, ultrasound scan parameters, type of surgical management and histological diagnosis were recorded. The primary outcome measure was the presence or absence of chorionic villi in the surgical specimen. Data were analysed using Mann Whitney U test for non-parametric data, relative risk for categorical data and binomial logistic regression.
A surgical specimen was obtained in 925 cases. Of these, 881/925 (95.2%) were positive for the presence of chorionic villi on histological examination. Patients with negative histology had a lower median gestational age, smaller ectopic pregnancies and lower serum human chorionic gonadotrophin levels. The relative risk of negative histology was significantly higher with a solid ectopic pregnancy on ultrasound (RR1.91, 95% CI 1.07-3.4) and with conservative surgery (RR 3.68, 95% CI 1.25-10.77). The relative risk was significantly lower with the presence of embryonic cardiac activity (RR 0.12, 95% CI 0.02-0.85). Only the serum hCG level was a significant predictor of negative histology on logistic regression analysis (p=0.048). In 39/44 women with negative histology, the human chorionic gonadotrophin level declined after surgery with no further intervention. Five of the 44 required a second surgical procedure as the ectopic pregnancy had been missed at the initial surgery and did not resolve.
There is lack of histological confirmation of sonographically diagnosed and surgically confirmed ectopic pregnancies in approximately 5% of cases, making this a relatively common finding following surgical treatment of tubal ectopic pregnancy. Clinicians should be aware of this when counselling women with tubal ectopic pregnancies about to undergo surgery, include this risk in the consent process and plan post-surgical follow up with this in mind.
确定输卵管异位妊娠治疗中手术标本的组织学检查结果，并将其与临床发现、术前超声扫描及手术类型相关联。
一项回顾性队列研究，研究对象为941名在伦敦国王学院医院早孕科被诊断为输卵管异位妊娠并接受手术治疗的女性。在2004年至2014年的11年期间，临床和超声数据已同步录入我们的电子早孕数据库及医院临床记录。记录人口统计学数据、临床病史、超声扫描参数、手术管理类型及组织学诊断。主要结局指标为手术标本中有无绒毛膜绒毛。使用Mann Whitney U检验分析非参数数据，使用相对风险分析分类数据，并进行二项逻辑回归分析。
925例获得了手术标本。其中，881/925（95.2%）在组织学检查中绒毛膜绒毛呈阳性。组织学检查为阴性的患者中位孕周较低，异位妊娠较小，血清人绒毛膜促性腺激素水平较低。超声显示为实性异位妊娠（RR 1.91，95%CI 1.07 - 3.4）及采用保守手术（RR 3.68，95%CI 1.25 - 10.77）时，组织学检查为阴性的相对风险显著更高。存在胚胎心脏活动时相对风险显著更低（RR 0.12，95%CI 0.02 - 0.85）。逻辑回归分析显示，只有血清hCG水平是组织学检查为阴性的显著预测因素（p = 0.048）。在44例组织学检查为阴性的女性中，39例术后人绒毛膜促性腺激素水平下降，无需进一步干预。44例中有5例需要进行二次手术，因为初次手术时遗漏了异位妊娠且未消退。
在约5%的病例中，超声诊断及手术确诊的异位妊娠缺乏组织学证实，这在输卵管异位妊娠手术治疗后是相对常见的发现。临床医生在为即将接受手术的输卵管异位妊娠女性提供咨询时应意识到这一点，在知情同意过程中提及此风险，并据此计划术后随访。
