Steiner R A, Ioannidis K, Wight E, Fehr M, Haller U
Departement für Frauenheilkunde, Universitätsspital, Zürich.
Schweiz Rundsch Med Prax. 1993 Oct 12;82(41):1117-21.
Of 147 patients operated by endoscopy, 86 (59%) were treated conservatively by linear salpingotomy or tubal aspiration and 61 (41%) were treated by salpingectomy. One patient with a history of bilateral salpingectomy had a cornual implantation and was also successfully treated by laparoscopic technique. There were no intraoperative complications. In eight patients (4.5%) with postoperative complications, a second operation was performed because of persistent trophoblast and/or hemorrhage. Six patients were treated by laparoscopic salpingectomy. All complications were associated with conservative treatment and typically occurred with a delay of up to 23 days. In six of these instances, the surgeon was rather inexperienced in laparoscopic operation. After an average follow-up time of 22 months, the pregnancy rate was 68%, of which 73% were intrauterine pregnancies. Laparoscopic treatment of ectopic pregnancies has proven to be an effective and safe procedure even at a teaching hospital. Since all complications occurred after conservative treatment this data suggests that salpingectomy should be the treatment of choice in ectopic pregnancy, whereas linear salpingotomy should only be performed when specially indicated.
在147例行内镜手术的患者中，86例（59%）接受了输卵管线性切开术或输卵管抽吸术的保守治疗，61例（41%）接受了输卵管切除术。1例有双侧输卵管切除病史的患者发生了宫角妊娠，也通过腹腔镜技术成功治疗。术中无并发症。8例（4.5%）患者出现术后并发症，因持续性滋养细胞和/或出血而进行了二次手术。6例患者接受了腹腔镜输卵管切除术。所有并发症均与保守治疗有关，通常在长达23天的延迟后发生。在其中6例中，外科医生在腹腔镜手术方面经验相当不足。平均随访22个月后，妊娠率为68%，其中73%为宫内妊娠。即使在教学医院，腹腔镜治疗异位妊娠已被证明是一种有效且安全的方法。由于所有并发症均发生在保守治疗后，该数据表明输卵管切除术应是异位妊娠的首选治疗方法，而输卵管线性切开术仅在有特殊指征时才应进行。
