Azoulay P
Service de Gynécologie-Obsétrique B, Hôpital de la Conception, Marseille.
Rev Fr Gynecol Obstet. 1994 Nov;89(11):547-52.
The pattern of ectopic pregnancy, defined by an ectopic site of the fertilised ovum, has changed in recent years in developed countries. It is only rarely responsible for maternal death in industrialised countries though the possibility remains (1/4000). However, it plays an increasing role in the pathophysiology of female infertility. In terms of epidemiology, the increase in its rate is linked to that of salpingitis and sexually transmitted diseases, and the sequelae of tubal surgery. Regarding symptomatology and prognosis, dramatic, life-threatening forms are in clear decline, because of the possibility of the early detection of pregnancy by sensitive and rapid assay of beta sub-unit human chorionic gonadotrophin (beta-hCG) and transvaginal ultrasonography. This enables conservative management regarding the tube, but is associated with the risk of recurrence. In terms of treatment, laparoscopic surgery is gradually taking the place of laparotomy. Such laparoscopic surgery must now be considered "theoretically" to be the reference treatment. Medical treatment methods using methotrexate are currently being evaluated and it is even possible in certain cases to suggest that no treatment is required.
近年来，发达国家中由受精卵着床于子宫外部位所定义的异位妊娠模式已发生变化。在工业化国家，它很少导致孕产妇死亡，尽管这种可能性依然存在（1/4000）。然而，它在女性不孕的病理生理学中所起的作用日益增大。从流行病学角度来看，其发病率的上升与输卵管炎、性传播疾病以及输卵管手术后遗症相关。在症状学和预后方面，由于能够通过灵敏快速的β亚单位人绒毛膜促性腺激素（β-hCG）检测及经阴道超声检查实现早期妊娠检测，严重的、危及生命的病例明显减少。这使得可以对输卵管进行保守治疗，但存在复发风险。在治疗方面，腹腔镜手术正逐渐取代剖腹手术。目前，此类腹腔镜手术必须在“理论上”被视为参考治疗方法。使用甲氨蝶呤的药物治疗方法目前正在评估中，甚至在某些情况下有可能无需进行治疗。
