Purpose

To investigate the association between different treatments of tubal ectopic pregnancy (EP) —expectant management, methotrexate (MTX), selected or recommended laparoscopic surgery—and the subsequent reproductive outcomes.

Methods

We conducted a retrospective cohort study including 228 EPs. The patients were divided into four treatment groups: 28 (12.3%) with expectant management successfully, 60 (26.3%) with MTX successfully, 140 patients with laparoscopic salpingectomy, of which 47 (20.6%) were assigned to selected surgery group because they opted for surgical treatment versus MTX, 93 (40.8%) were assigned to recommended surgery group as recommended by the attending physician.

Results

The recommended surgery group had the lowest rate of intrauterine pregnancy (IUP) (77.42%) and live birth (LB) (72.04%), while the incidence of recurrent EP (REP) (20.43%) was the highest, but the statistical differences were not significant. We did not observe significant differences of the EP-IUP time interval, rates of LB and miscarriage (MIS) between the four groups. Compared to the MTX group, recommended surgery was negatively associated with IUP (adjusted OR, 95%CI: 0.34, 0.11–1.03) and LB (0.35, 0.14–0.92), while it had higher risk for REP (3.48, 1.03–11.74) in the subsequent pregnancy. Further, compared to selective surgery group, recommended surgery was negatively associated with IUP (0.15, 0.03–0.68) and LB (0.23, 0.07–0.74), while it had higher risk for REP (6.83, 1.43–32.67) in the subsequent pregnancy. Expectant treatment was negatively associated with assisted reproductive technology (ART) (0.08, 0.02–0.40) compared with MTX. Of the185 patients who had LBs, all adverse outcomes were not statistically different between the four groups.

Conclusion

Patients with recommended laparoscopic salpingectomy had worse reproductive outcomes than the other treatment groups. The disease status of EP may play an important role in the association rather than the surgery alone.

中文翻译：

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输卵管异位妊娠：5年内临床特征、治疗方案和生育结局的回顾性队列研究

目的

调查输卵管异位妊娠 (EP) 的不同治疗方法——期待治疗、甲氨蝶呤 (MTX)、选择或推荐的腹腔镜手术——与随后的生殖结果之间的关联。

方法

我们进行了一项回顾性队列研究，包括 228 个 EP。患者分为四个治疗组：28 例（12.3%）期待治疗成功，60 例（26.3%）MTX 成功，140 例腹腔镜输卵管切除术，其中 47 例（20.6%）被分配到选定手术组，因为他们选择对于手术治疗与 MTX 相比，93 例 (40.8%) 被分配到主治医师推荐的推荐手术组。

结果

推荐手术组宫内妊娠（IUP）（77.42%）和活产（LB）率（72.04%）最低，复发性EP（REP）发生率（20.43%）最高，但差异有统计学意义并不重要。我们没有观察到四组之间的 EP-IUP 时间间隔、LB 率和流产率 (MIS) 存在显着差异。与 MTX 组相比，推荐手术与 IUP（调整后的 OR，95%CI：0.34，0.11-1.03）和 LB（0.35，0.14-0.92）呈负相关，而 REP 风险更高（3.48，1.03-11.74） ) 在随后的怀孕中。此外，与选择性手术组相比，推荐手术与 IUP (0.15, 0.03–0.68) 和 LB (0.23, 0.07–0.74) 呈负相关，而其在随后的妊娠中具有更高的 REP (6.83, 1.43–32.67) 风险. 与 MTX 相比，期待治疗与辅助生殖技术 (ART) (0.08, 0.02–0.40) 呈负相关。在 185 名患有 LB 的患者中，四组之间的所有不良结果均无统计学差异。

结论

推荐的腹腔镜输卵管切除术患者的生殖结果比其他治疗组差。EP 的疾病状态可能在关联中起重要作用，而不仅仅是手术。