Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, Rhode Island (Drs. Ozcan and Frishman).
W.P. Carey School of Business, Arizona State University, Tempe, Arizona (Dr. Wilson).
J Minim Invasive Gynecol. 2021 Mar;28(3):656-667. doi: 10.1016/j.jmig.2020.10.014. Epub 2020 Oct 24.
To evaluate the fertility outcomes of salpingectomy compared with those of salpingostomy among patients treated for tubal ectopic pregnancies, including a separate analysis of women with risk factors along with a review of the surgical technique.
Systematic review and meta-analysis from 1990 to the present through PubMed, Embase, CINAHL, and Ovid MEDLINE. The search string included "tubal pregnancy" or "ectopic" as well as "salpingectomy" and various terms describing salpingotomy.
Articles studying women who underwent surgical management of an ectopic pregnancy and the contrasted outcomes of salpingectomy vs salpingostomy were reviewed. The primary outcomes included subsequent intrauterine pregnancy (IUP) and repeat ectopic pregnancy (REP).
TABULATION, INTEGRATION, AND RESULTS: Two randomized controlled trials (RCTs), which consisted mostly of patients classified as low risk, and patients from 16 cohort studies were included. In the RCTs, there was no significant difference in the odds of subsequent IUP in patients who underwent a salpingectomy compared with those who were treated with salpingotomy (odds ratio [OR] 0.97; 95% confidence interval [CI], 0.71-1.33). However, a significant and clinically meaningful difference was noted in the cohort studies, with the patients having a lower chance of IUP after salpingectomy (OR 0.45; 95% CI, 0.39-0.52). No significant difference was noted in the OR for a REP in the randomized trials (OR 0.77; 95% CI, 0.41-1.47), but the patients followed in the cohort studies had a cumulatively higher risk of REP after a salpingostomy (OR 0.73; 95% CI, 0.60-0.90). The subgroup analysis examining women within the studies with risk factors for tubal pathology found an even more impressive lowering in the odds of a subsequent IUP in patients classified as at-risk who were treated with salpingectomy (OR 0.30; 95% CI, 0.17-0.54), with a change in the direction of the odds for an REP rate favoring those who were treated with salpingostomy (OR 1.96; 95% CI, 0.88-4.35).
Salpingectomy has clear advantages over salpingostomy, and RCTs consisting mainly of patients classified as low risk show no difference in outcomes between salpingectomy and salpingostomy. However, in cohort studies inclusive of all patients, the likelihood of a subsequent spontaneous IUP is decreased in patients treated with salpingectomy, and salpingostomies may be especially underused in women with risk factors for tubal disease.
评估输卵管切除术与输卵管切开术治疗输卵管异位妊娠患者的生育结局，包括对有风险因素的女性进行单独分析，并对手术技术进行综述。
1990 年至目前为止通过 PubMed、Embase、CINAHL 和 Ovid MEDLINE 进行的系统评价和荟萃分析。搜索词包括“输卵管妊娠”或“异位妊娠”以及“输卵管切除术”和各种描述输卵管切开术的术语。
回顾了对接受异位妊娠手术治疗的女性进行研究，并对输卵管切除术与输卵管切开术的对比结果进行了研究。主要结局包括后续宫内妊娠（IUP）和重复异位妊娠（REP）。
列表、整合和结果：纳入了两项随机对照试验（RCT），这些 RCT 主要包括分类为低风险的患者和来自 16 项队列研究的患者。在 RCT 中，与接受输卵管切开术的患者相比，接受输卵管切除术的患者随后发生 IUP 的几率没有显著差异（比值比[OR]0.97；95%置信区间[CI]0.71-1.33）。然而，在队列研究中，观察到了有显著且有临床意义的差异，接受输卵管切除术的患者发生 IUP 的几率较低（OR 0.45；95%CI 0.39-0.52）。在 RCT 中，REP 的 OR 没有显著差异（OR 0.77；95%CI 0.41-1.47），但在队列研究中随访的患者在接受输卵管切开术后面临更高的 REP 风险（OR 0.73；95%CI 0.60-0.90）。对研究中存在输卵管病理风险因素的女性进行亚组分析发现，对分类为高危的患者进行输卵管切除术治疗后，IUP 发生几率显著降低（OR 0.30；95%CI 0.17-0.54），而 REP 发生率的几率有利于接受输卵管切开术治疗的患者（OR 1.96；95%CI 0.88-4.35）。
输卵管切除术明显优于输卵管切开术，主要由低危患者组成的 RCT 显示输卵管切除术和输卵管切开术的结局没有差异。然而，在包含所有患者的队列研究中，接受输卵管切除术治疗的患者发生后续自发性 IUP 的可能性降低，并且对有输卵管疾病风险因素的女性来说，输卵管切开术的应用可能不足。
