Takashima Kunitomo, Yoshida Hiroshi, Murase Mariko, Sato Aya, Sakakibara Hideya, Hirahara Fumiki, Ishikawa Masahiko
Department of Gynecology Yokohama City University, Medical Center Hospital 4-57 Urafune-cho, Minami-ku Yokohama Kanagawa Japan.
Department of Obstetrics and Gynecology Yokohama City University School of Medicine 3-9 Fukuura, Kanazawa-ku Yokohama Kanagawa Japan.
Reprod Med Biol. 2009 Jul 1;8(3):119-123. doi: 10.1007/s12522-009-0022-0. eCollection 2009 Sep.
To identify predictive factors for successful expectant management of ectopic pregnancy and to evaluate the prognosis for fertility after expectant management and laparoscopic salpingostomy.
Forty-six cases of expectant management and eighty cases of laparoscopic salpingostomy for tubal ectopic pregnancy were retrospectively analyzed. Subjects were classified in three groups: those who underwent laparoscopic salpingostomy, those treated by expectant management only, and those treated by expectant management but requiring additional treatment.
The rates of tubal patency, intrauterine pregnancy and repeated ectopic pregnancy in the laparoscopic salpingostomy group were 75, 40, and 16%. The rates in the expectant management group were not significantly different: 72, 42 and 15%. Finally, the rates in the extra treatment group were 75, 39 and 15%. Success rate of expectant management was 54%. In 93% of cases expectant management was successfully completed when the initial levels of urinal hCG were less than 3000 mIU/ml and the levels of hCG 48 h later were less than 80% of the initial levels. However, expectant management alone was insufficient and required extra treatment in 90% of cases when the initial levels of hCG were 3000 mIU/ml and above or when the levels of hCG level 48 h later was 80% of initial levels and above.
Expectant management in combination with salpingostomy is not only minimally invasive but also a useful way to preserve fertility. Initial urine hCG levels and their variation over time can help predict whether expectant management will succeed.
确定异位妊娠期待治疗成功的预测因素，并评估期待治疗及腹腔镜输卵管造口术后的生育预后。
回顾性分析46例异位妊娠期待治疗病例和80例腹腔镜输卵管造口术治疗输卵管异位妊娠病例。将研究对象分为三组：接受腹腔镜输卵管造口术的患者、仅接受期待治疗的患者以及接受期待治疗但需要额外治疗的患者。
腹腔镜输卵管造口术组的输卵管通畅率、宫内妊娠率和重复异位妊娠率分别为75%、40%和16%。期待治疗组的这些比率无显著差异：分别为72%、42%和15%。最后，额外治疗组的比率分别为75%、39%和15%。期待治疗的成功率为54%。当尿hCG初始水平低于3000 mIU/ml且48小时后的hCG水平低于初始水平的80%时，93%的病例期待治疗成功完成。然而，当hCG初始水平为3000 mIU/ml及以上或48小时后的hCG水平为初始水平的80%及以上时，90%的病例仅靠期待治疗是不够的，需要额外治疗。
期待治疗联合输卵管造口术不仅微创，而且是一种保留生育能力的有效方法。初始尿hCG水平及其随时间的变化有助于预测期待治疗是否会成功。
