澳大利亚异位妊娠手术治疗现状及趋势

Present Status and Trends in Surgical Management of Ectopic Pregnancy in Australia

目的分析澳大利亚异位妊娠手术治疗的现状及发展趋势。方法根据Medicare Australia提供的1994年1月-2008年12月异位妊娠手术9638例,其中腹腔镜手术6878例,开腹手术2760例,进行回顾性分析。结果1994-2008年,澳大利亚全国及各州区异位妊娠手术病例数呈明显下降趋势（P〈0.001）;1994年腹腔镜手术比例由51.3%（504/982）上升至2008年90.8%（417/459）,呈明显上升趋势（P〈0.0001）;开腹手术比例由1994年48.7%（478/982）下降至2008年9.2%（42/459）,呈明显下降趋势（P〈0.0001）。结论澳大利亚异位妊娠手术治疗病例数量的下降提示早期诊断和药物保守治疗可能对其治疗产生了明显的影响,腹腔镜手术已成为异位妊娠手术治疗的首要选择,有望取代开腹手术。

Objective To analyze the present status and trends in the surgical management of ectopic pregnancy（EP）in Australia.Methods A retrospective study of Medicare Australia data from 1994 to 2008 was analyzed.Totally 9638 patients with EP who received surgery during the period were enrolled in this study.Among the cases,laparoscopy was used in 6878 patients,and open surgery was performed on 2760 cases.Results Nine thousand six hundred and thirty-eight cases of EP surgery were revealed,including 6878 cases with laparoscopic surgery and 2760 cases with open abdominal surgery.The total number of surgical cases for EP decreased in individual State Territory in Australia between 1994 and 2008.It demonstrated a significant decreasing trend（P〈0.001）.The laparoscopic approach percentage has increased from 51.3%（504/982）in 1994 to 90.8%（417/459）in 2008.This increasing trend in laparoscopic surgery for the management of EP was statistically significant（P〈0.0001）.There was a statistically significant decreasing trend of open abdominal surgery from 48.7%（478/982）in 1994 to 9.2%（42/459）in 2008 at the same period（P〈0.0001）.Conclusions The trend of decreasing surgical cases suggests that the early diagnosis and conservative medical treatment may have a great impact on the surgical management of EP in Australia.Laparoscopy has become the primary approach for the surgical management of EP,and it may totally replace open abdominal surgery.