Mol B W, Matthijsse H C, Tinga D J, Huynh T, Hajenius P J, Ankum W M, Bossuyt P M, van der Veen F
Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, The Netherlands.
Hum Reprod. 1998 Jul;13(7):1804-9. doi: 10.1093/humrep/13.7.1804.
A retrospective cohort study was set up to evaluate the effectiveness of conservative and radical surgery for tubal pregnancy towards subsequent fertility. Consecutive patients undergoing conservative or radical surgery for tubal pregnancy between January 1990 and August 1993 in two university hospitals were included in the study. Outcome measures were spontaneous intrauterine pregnancy (IUP) and repeat ectopic pregnancy (EP). Of the 135 patients analysed, 56 underwent conservative surgery and 79 underwent radical surgery. Patients treated with conservative surgery achieved a higher 3-year cumulative pregnancy rate than those treated radically (P < 0.001, log-rank test). In patients treated conservatively, there was only one spontaneous IUP in the period between 18 months and 3 years after the tubal pregnancy. In contrast, patients treated radically continued to conceive in this period. Multivariate analysis showed a fecundity rate ratio (FRR) of 1.9 [95% confidence interval (CI): 0.91 to 3.8] for IUP after conservative surgery in the first 18 months of follow-up. In patients with a history of bilateral tubal disease the FRR was 3.1 (95% CI: 0.76 to 12), whereas in patients without a history of bilateral tubal disease the FRR was 1.4 (95% CI: 0.13 to 16). The FRR for repeat EP was 2.4 (95% CI: 0.57 to 11). Our data indicate a beneficial effect of conservative surgery towards subsequent fertility that was not, however, statistically significant in the multivariate analysis. In view of these inconclusive data and the importance of this major health problem, randomized studies are required to assess whether conservative surgery really improves the fertility prospects of patients with tubal pregnancy.
开展了一项回顾性队列研究，以评估输卵管妊娠保守手术和根治性手术对后续生育能力的有效性。1990年1月至1993年8月期间，两所大学医院中接受输卵管妊娠保守手术或根治性手术的连续患者被纳入该研究。观察指标为自然宫内妊娠（IUP）和重复异位妊娠（EP）。在分析的135例患者中，56例行保守手术，79例行根治性手术。接受保守手术治疗的患者3年累积妊娠率高于接受根治性手术的患者（P<0.001，对数秩检验）。在接受保守治疗的患者中，输卵管妊娠后18个月至3年期间仅有1例自然IUP。相比之下，接受根治性治疗的患者在此期间仍能受孕。多变量分析显示，随访前18个月保守手术后IUP的生育力比率（FRR）为1.9[95%置信区间（CI）：0.91至3.8]。有双侧输卵管疾病史的患者FRR为3.1（95%CI：0.76至12），而无双侧输卵管疾病史的患者FRR为1.4（95%CI：0.13至16）。重复EP的FRR为2.4（95%CI：0.57至11）。我们的数据表明保守手术对后续生育能力有有益影响，然而，在多变量分析中这一影响无统计学意义。鉴于这些不确定的数据以及这一重大健康问题的重要性，需要进行随机研究来评估保守手术是否真的能改善输卵管妊娠患者的生育前景。
