Maymon R, Shulman A
Department of Obstetrics, Assaf Harofeh Medical Center, Tel Aviv, Israel.
Hum Reprod Update. 1996 Nov-Dec;2(6):541-51. doi: 10.1093/humupd/2.6.541.
The two main conservative treatment alternatives for tubal pregnancy, methotrexate administration and laparoscopic salpingostomy are under constant review. Recently, expectant management of tubal pregnancy has become increasingly popular. In this review, we assess the outcome of conservative management modalities for extrauterine pregnancy and compare the results of treatment with methotrexate and operative laparoscopy. Outcomes of extrauterine pregnancy were obtained from a review compiled from the English literature identified by directed Medline search. Methotrexate and laparoscopic salpingostomies yield good final treatment rates of 85-95% respectively and relatively low rates for further surgical complication (5-10% respectively). Tubal patency, as well as future fertility performance, are quite similar after both techniques. Although they appear to suit the demands of the 21st century, each one has its own benefits and contraindications. With adequate patient selection, expectant management of the tubal pregnancy is a reasonable approach with good results. Although the morbidity rate after tubal pregnancy treatment is decreasing and the main concern is to reduce the decline in fertility potential, the real future challenge remains prevention of the disease, especially among high risk patients, such as those undergoing infertility treatment.
输卵管妊娠的两种主要保守治疗方法，即甲氨蝶呤给药和腹腔镜输卵管造口术，一直在不断评估中。近年来，输卵管妊娠的期待疗法越来越受欢迎。在本综述中，我们评估了宫外孕保守治疗方式的结果，并比较了甲氨蝶呤治疗与手术腹腔镜检查的结果。宫外孕的结果来自通过定向Medline搜索确定的英文文献综述。甲氨蝶呤和腹腔镜输卵管造口术的最终治疗成功率分别为85-95%，进一步手术并发症发生率相对较低（分别为5-10%）。两种技术后的输卵管通畅率以及未来生育能力表现相当相似。尽管它们似乎符合21世纪的需求，但每种方法都有其自身的优点和禁忌症。通过适当的患者选择，输卵管妊娠的期待疗法是一种合理的方法，效果良好。虽然输卵管妊娠治疗后的发病率正在下降，主要关注点是减少生育潜力的下降，但真正未来的挑战仍然是预防该疾病，特别是在高危患者中，如接受不孕症治疗的患者。
