Rulin M C
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Magee-Womens Hospital, Pennsylvania, USA.
Obstet Gynecol. 1995 Dec;86(6):1010-3. doi: 10.1016/0029-7844(95)00330-T.
Salpingostomy has gradually replaced salpingectomy as the surgical procedure of choice for unruptured tubal pregnancy in women who wish to preserve fertility. There are no prospective studies and only a few retrospective reports comparing fertility rates after salpingostomy and salpingectomy. Three major retrospective studies found no significant difference in fertility or incidence of repeat ectopic pregnancy between the two procedures, but salpingostomy carries a 5-8% risk of persistent ectopic pregnancy, contributing to increased morbidity and cost. There are approximately 109,000 ectopic pregnancies per year in the United States. If half are treated by salpingostomy, 54,500 women will need serial beta-hCG testing after surgery. Approximately 3543 will have a persistent ectopic pregnancy requiring surgical or medical treatment. The additional direct costs created by persistent ectopic pregnancy is estimated to be almost $16,000,000. Fertility after ectopic pregnancy is affected much more by the status of the contralateral tube than by the procedure performed, with fertility rates exceeding 80% after salpingectomy when the opposite tube is normal. By performing salpingectomy when the contralateral tube is normal, half the additional cost and morbidity could be avoided without jeopardizing subsequent fertility.
输卵管造口术已逐渐取代输卵管切除术，成为希望保留生育能力的未破裂输卵管妊娠女性的首选手术方式。目前尚无前瞻性研究，仅有少数回顾性报告比较了输卵管造口术和输卵管切除术后的生育率。三项主要的回顾性研究发现，这两种手术在生育率或重复异位妊娠发生率方面无显著差异，但输卵管造口术有5% - 8%的持续性异位妊娠风险，会导致发病率增加和成本上升。美国每年约有109,000例异位妊娠。如果一半患者接受输卵管造口术治疗，那么术后54,500名女性将需要进行连续的β - hCG检测。大约3543人会发生持续性异位妊娠，需要手术或药物治疗。持续性异位妊娠产生的额外直接成本估计近1600万美元。异位妊娠后的生育能力受对侧输卵管状况的影响远大于所施行的手术方式，当对侧输卵管正常时，输卵管切除术后的生育率超过80%。当对侧输卵管正常时施行输卵管切除术，可避免一半的额外成本和发病率，且不会危及后续生育能力。
