输卵管切除与输卵管开窗取胚术输卵管妊娠的Meta分析

Salpingotomy versus salpingectomy for the treatment of tubal ectopic pregnancy: a meta-analysis

目的通过对宫腔内妊娠率、持续性异位妊娠率及异位妊娠复发率三个指标,评价输卵管开窗取胚和输卵管切除术两种手术方式。方法计算机检索PubMed、Embase和Cochrane图书馆,对纳入研究进行质量评价及Meta分析,对研究中提取的数据用Rev Man 5.2软件进行处理。结果总纳入14个试验进行系统分析,在24个月的随访过程中,输卵管开窗取胚术相比于输卵管切除治疗具有更高的持续性异位妊娠率(RR 15.41,95%CI:3.99～59.60)和宫内妊娠率(RR 1.20,95%CI:1.10～1.31)。而长于36个月的随访宫内妊娠率两组差异无统计学意义(RR 1.35,95%CI:0.99～1.84)。术后复发率在随访24个月和36个月差异无统计学意义(RR 1.04,95%CI:0.82～1.31)和(RR 1.18,95%CI:0.75～1.86)。结论输卵管开窗取胚和输卵管切除术对异位妊娠都是有效和安全的治疗方式,但输卵管开窗取胚术是有输卵管病史或其他不孕因素的患者的首选治疗方式。

To evaluate the intrauterine pregnancy rate,persistent ectopic pregnancy rate and ectopic pregnancy recurrence rate between two types of surgeries.We searched PubMed,EMbase,and the Cochrane Library.We evaluated the quality of relative literatures and performed a mata-analysis.The extracted data were analyzed with ReyMan software.Total 14 trials were included.Compared to salpingectomy,salpingotomy had significantly higher persistent ectopic pregnancy rate(RR=15.41,95%CI:3.99~59.60)and intrauterine pregnancy rate(RR 1.20,95%CI:1.10~1.31)during 24-month follow-up.However,there was no significant difference in intrauterine pregnancy rate during 36-month follow-up between the two types of surgery(RR 1.35,95%CI:0.99~1.84).There was also no difference in ectopic pregnancy recurrence rate between the two types of surgery during either 24-month or 36-month follow-up.Both salpingotomy and salpingectomy are effective and safe to deal with ectopic pregnancy.Salpingotomy would be a better method for the patient with wounded salpinx or any other infertility factors.