Klein M, Kiss H, Beck A, Spitzer D, Graf A, Wellenhofer A, Egarter C, Husslein P
Gynäkologische Abteilung, Hanusch-Krankenhaus, Wien.
Geburtshilfe Frauenheilkd. 1994 Feb;54(2):89-91. doi: 10.1055/s-2007-1023559.
As local drug treatment grew more common, the risk of persisting trophoblast remnants increased in tubal pregnancies treated in this way. We studied the secondary surgical measures in 52 patients, who had to undergo surgery for a second time after tubal pregnancy treated with prostaglandins. The indication for revision was arrived at 30 times on the basis of laboratory parameters (increasing or constant beta-HCG) (Group I). Reoperation had to be performed 22 times because of acute clinical symptoms (Group II). Laparotomy was performed 40 times, repelviscopy 12 times. In patients of Group I, the rate of rupture, that, had already occurred at the time of secondary surgery, was significantly smaller (p < 0.0001); in that case secondary surgery was significantly more often successful (p < 0.06) in preserving the tubes. In case of constant beta-HCG values 11 patients (50% of Group II) developed acute symptoms; another 7 patients (31.8%) also had to be reoperated on due to acute complaints, although the values were already clearly reduced. The study proves, that tubal pregnancies can be reoperated with preservation of the tubes even after unsuccessful prostaglandin therapy. The starting position for secondary surgery with preservation of the tubes is much better before acute clinical symptoms occur.
随着局部药物治疗变得越来越普遍，以这种方式治疗的输卵管妊娠中持续存在滋养层残留物的风险增加。我们研究了52例患者的二次手术措施，这些患者在用前列腺素治疗输卵管妊娠后不得不再次接受手术。基于实验室参数（β-HCG升高或持续）有30次进行二次手术的指征（第一组）。由于急性临床症状，不得不进行再次手术22次（第二组）。进行剖腹手术40次，腹腔镜检查12次。在第一组患者中，二次手术时已经发生的破裂率明显较低（p < 0.0001）；在这种情况下，二次手术在保留输卵管方面明显更常成功（p < 0.06）。在β-HCG值持续的情况下，11例患者（第二组的50%）出现急性症状；另外7例患者（31.8%）也因急性症状不得不再次手术，尽管数值已经明显下降。该研究证明，即使前列腺素治疗失败，输卵管妊娠也可以在保留输卵管的情况下进行再次手术。在急性临床症状出现之前，保留输卵管进行二次手术的起始状况要好得多。
