Chiu Nai-Chi, Ho Chi-Hong, Shen Shu-Huei, Tsuei Yu-Chuan, Lee Kang-Lung, Huang Chen-Yu, Li Hsin-Yang, Chen Tzeng-Ji
Department of Radiology Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Beitou District, Taipei City, Taiwan, R.O.C; and School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C School of Medicine, National Yang-Ming University; School of Biomedical Science and Engineering, National Yang-Ming University, Taipei, Taiwan, R.O.C; and Department of Orthopaedics, Cheng Hsin General Hospital, Taipei City, Taiwan R.O.C Department of Family Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan, R.O.C; and Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.
Medicine (Baltimore). 2017 Jun;96(25):e7263. doi: 10.1097/MD.0000000000007263.
By retrieving records from Taiwan's National Health Insurance (NHI) system's database, the current study aimed to investigate the impacts of hysterosalpingography (HSG) to patients after ectopic pregnancy (EP) operations in Taiwan.In this retrospective cohort study, insurance claims data from 1997 to 2013, derived from a cohort of 1 million people randomly sampled to represent all NHI beneficiaries, were analyzed. Patients after ectopic pregnancy (EP) operations were identified via the inclusion of the corresponding NHI procedure codes. We further divided the patients into 2 groups by whether received subsequent HSG, EP-HSG, and EP-no-HSG. Patients with history of previous pregnancies (PP) and subsequent HSG were grouped as PP-HSG. We sought to evaluate the following pregnancies (FP) rate, interval to FP in EP-HSG compared with that in EP-no-HSG, and PP-HSG.EP-HSG had significantly higher FP rate odds ratio than EP-no-HSG (OR, 1.64; 95% CI, 1.24-2.16, P < .001). EP-HSG had lower FP rate odds ratio than that in PP-HSG, but no significant difference (33.1% vs 34.6%, P = .654). The INTERVAL(HSG-FP) in EP-HSG was no significantly different from that in PP-HSG (843.34 ± 82 days vs 644.72 ± 24.30 days, P = .077). There was significant positive correlation between FP after EP and number of HSG (r = 0.070, P < .001). There were significant negative correlation between FP and EP age (r = -0.270, P < .001), FP and INTERVAL(EP-HSG) (r = -0.212, P = .001). The multivariate analysis showed that INTERVAL(EP-HSG) less than 1 year is the predictor factor of INTERVAL(EP-FP) (hazard ratio: 1.422; 95% CI: 1.130-1.788; P = .003). It was evident that the longer the INTERVAL(EP-HSG), the lower the FP rate odds ratio; and the older the EP age, the lower the FP rate odds ratio. (OR, 95% CI; >1 year: 0.59, 0.41-0.86; >2 year: 0.42, 0.32-0.55; >25 years old: 0.47, 0.38-0.57; >30 years old: 0.29, 0.24-0.35; >35 years old: 0.12, 0.08-0.18, all P < .001).Receiving HSG after EP, short INTERVAL(EP-HSG), EP age less than 30 years old, had significant positive impacts on the FP. We encourage shortening the INTERVAL(EP-HSG), and the counseling of women on the most appropriate way to conceive thereafter.
通过检索台湾全民健康保险（NHI）系统数据库中的记录，本研究旨在调查子宫输卵管造影术（HSG）对台湾异位妊娠（EP）手术后患者的影响。在这项回顾性队列研究中，分析了1997年至2013年从100万人队列中随机抽取的保险理赔数据，该队列代表了所有NHI受益人。通过纳入相应的NHI程序代码来识别异位妊娠（EP）手术后的患者。我们根据是否接受后续HSG将患者进一步分为两组，即EP-HSG组和EP-no-HSG组。有既往妊娠史（PP）且接受后续HSG的患者被归为PP-HSG组。我们试图评估以下妊娠（FP）率、EP-HSG组与EP-no-HSG组相比至FP的间隔时间，以及PP-HSG组的情况。EP-HSG组的FP率优势比显著高于EP-no-HSG组（OR = 1.64；95% CI：1.24 - 2.16，P <.001）。EP-HSG组的FP率优势比低于PP-HSG组，但无显著差异（33.1%对34.6%，P = 0.654）。EP-HSG组至FP的间隔时间（HSG-FP）与PP-HSG组无显著差异（843.34 ± 82天对644.72 ± 24.30天，P = 0.077）。EP后FP与HSG次数之间存在显著正相关（r = 0.070，P <.001）。FP与EP年龄之间存在显著负相关（r = -0.270，P <.001），FP与至HSG的间隔时间（EP-HSG）之间存在显著负相关（r = -0.212，P = 0.001）。多因素分析表明，至HSG的间隔时间（EP-HSG）小于1年是至FP间隔时间（EP-FP）的预测因素（风险比：1.422；95% CI：1.130 - 1.788；P = 0.003）。显然，至HSG的间隔时间（EP-HSG）越长，FP率优势比越低；EP年龄越大，FP率优势比越低。（OR，95% CI；>1年：0.59，0.41 - 0.86；>2年：0.42，0.32 - 0.55；>25岁：0.47，0.38 - 0.57；>30岁：0.29，0.24 - 0.35；>35岁：0.12，0.08 - 0.18，所有P <.001）。EP后接受HSG、至HSG的间隔时间短、EP年龄小于30岁，对FP有显著的正向影响。我们鼓励缩短至HSG的间隔时间（EP-HSG），并为女性提供关于此后最适宜受孕方式的咨询。
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