Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, People's Republic of China.
Clinical Research Center, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, People's Republic of China.
Arch Gynecol Obstet. 2022 Dec;306(6):2055-2062. doi: 10.1007/s00404-022-06690-2. Epub 2022 Aug 29.
To investigate the association between different treatments of tubal ectopic pregnancy (EP) -expectant management, methotrexate (MTX), selected or recommended laparoscopic surgery-and the subsequent reproductive outcomes.
We conducted a retrospective cohort study including 228 EPs. The patients were divided into four treatment groups: 28 (12.3%) with expectant management successfully, 60 (26.3%) with MTX successfully, 140 patients with laparoscopic salpingectomy, of which 47 (20.6%) were assigned to selected surgery group because they opted for surgical treatment versus MTX, 93 (40.8%) were assigned to recommended surgery group as recommended by the attending physician.
The recommended surgery group had the lowest rate of intrauterine pregnancy (IUP) (77.42%) and live birth (LB) (72.04%), while the incidence of recurrent EP (REP) (20.43%) was the highest, but the statistical differences were not significant. We did not observe significant differences of the EP-IUP time interval, rates of LB and miscarriage (MIS) between the four groups. Compared to the MTX group, recommended surgery was negatively associated with IUP (adjusted OR, 95%CI: 0.34, 0.11-1.03) and LB (0.35, 0.14-0.92), while it had higher risk for REP (3.48, 1.03-11.74) in the subsequent pregnancy. Further, compared to selective surgery group, recommended surgery was negatively associated with IUP (0.15, 0.03-0.68) and LB (0.23, 0.07-0.74), while it had higher risk for REP (6.83, 1.43-32.67) in the subsequent pregnancy. Expectant treatment was negatively associated with assisted reproductive technology (ART) (0.08, 0.02-0.40) compared with MTX. Of the185 patients who had LBs, all adverse outcomes were not statistically different between the four groups.
Patients with recommended laparoscopic salpingectomy had worse reproductive outcomes than the other treatment groups. The disease status of EP may play an important role in the association rather than the surgery alone.
探讨不同输卵管妊娠（EP）治疗方法（期待治疗、甲氨蝶呤[MTX]、选择性或推荐性腹腔镜手术）与后续生殖结局的关系。
我们进行了一项回顾性队列研究，纳入了 228 例 EP 患者。将患者分为四组治疗：28 例（12.3%）期待治疗成功，60 例（26.3%）MTX 治疗成功，140 例行腹腔镜输卵管切除术，其中 47 例（20.6%）因选择手术治疗而非 MTX 治疗而被归入选择性手术组，93 例（40.8%）因医生推荐而归入推荐性手术组。
推荐性手术组宫内妊娠（IUP）率（77.42%）和活产（LB）率（72.04%）最低，而复发性 EP（REP）发生率（20.43%）最高，但差异无统计学意义。四组间 EP-IUP 时间间隔、LB 和流产（MIS）率无显著差异。与 MTX 组相比，推荐性手术与 IUP（调整后的 OR，95%CI：0.34，0.11-1.03）和 LB（0.35，0.14-0.92）呈负相关，而在后续妊娠中 REP 风险更高（3.48，1.03-11.74）。此外，与选择性手术组相比，推荐性手术与 IUP（0.15，0.03-0.68）和 LB（0.23，0.07-0.74）呈负相关，而在后续妊娠中 REP 风险更高（6.83，1.43-32.67）。与 MTX 相比，期待治疗与辅助生殖技术（ART）呈负相关（0.08，0.02-0.40）。在 185 例有 LB 的患者中，四组间所有不良结局均无统计学差异。
推荐性腹腔镜输卵管切除术患者的生殖结局较其他治疗组差。EP 的疾病状态可能在这种关联中起重要作用，而不仅仅是手术本身。
