摘要
目的:评价腹腔镜下保守手术及根治手术治疗输卵管妊娠的生育结局,为临床应用提供证据。方法:采用计算机和手工检索主题词的方法,检索Pub Med、EMBASE、Wiley Online Library、Cochrane Library、Google Scholar、CBM、Wanfang Data和CNKI Data,检索时限从建库至2012年12月,纳入有关腹腔镜下保守手术及根治手术治疗输卵管妊娠比较的相关文献,对检索到的文献进行质量评价,采用Rev Man 5.2软件进行Meta分析。结果:纳入15个队列研究,共2880例患者。Meta分析结果显示,保守手术组持续性异位妊娠率(6.6%)显著高于根治手术组(0.6%),差异有统计学意义(RR=6.45,95%CI 1.47～28.22,P=0.01)。保守手术组术后宫内妊娠率(70.1%)高于根治手术组(50.5%),差异有统计学意义(RR=1.43,95%CI 1.21～1.69,P<0.01),而两者对侧输卵管通畅情况及再次异位妊娠率比较,差异无统计学意义(RR=1.01,95%CI 0.67～1.54,P=0.96;RR=0.98,95%CI 0.82～1.17,P=0.85)。结论:保守手术比根治手术治疗输卵管妊娠有更高的持续性异位妊娠率和术后宫内妊娠率,但不增加再次异位妊娠率,并且两者对侧输卵管通畅情况相似。
Objective.To compare the fertility outcome after laparoscopic conservative surgery and laparo- scopic radical surgery in treatment of tubal pregnancy,so as to provide evidence for clinical application. Meth- ods： Randomized controlled trials （RCTs） or cohort studies that comparing laparoscopic conservative surgery and laparoscopic radical surgery for treatment of tubal pregnancy were searched in Pub Med, EMBASE,Wi- ley Online Library,Cochrane Library,Google Scholar, CBM, WanFang Data and CNKI Data etc （till Decem- ber 2012）. The quality of included RCTs or cohort studies was evaluated,and Meta-analysis was performed with Rev Man 5.2 software. Results： 15 studies were included,involving 1892 women in conservative surgery group,and 988 women in radical surgery group. The results of Meta-analysis showed that persistent ectopic pregnancy（PEP） rate in conservative surgery group was significantly higher than that in radical surgery group（ RR=6.45,95%CI 1.47 -28.22, P=0.01 ）. Compared to radical surgery group,conservative surgery group has a higher intrauterine pregnancy rate （ RR - 1.43,95% CI 1.21 - 1.69, P 〈 0. 01 ）. There was no significant difference in contralateral oviduct tube patency situation （ RR = 1.01,95% CI 0.67 - 1.54, P = 0. 96） and recurrence of ectopic pregnancy rate（ RR = 0.98,95% CI 0. 82 - 1.17, P = 0. 85 ） between the two groups. Conclusions：Compared to laparoscopic radical surgery,conservative surgery has higher persistent ectopic pregnancy rate and intrauterine pregnancy rate,and has similar recurrence of ectopic pregnancy rate and contralateral oviduct tubes situation.
出处
《实用妇产科杂志》
CAS
CSCD
北大核心
2013年第10期757-761,共5页
Journal of Practical Obstetrics and Gynecology
关键词
腹腔镜
保守手术
根治手术
输卵管妊娠
Laparoscope
Conservative surgery
Radical surgery
Tubal pregnancy
