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Re-evaluation of the Indication and Limitation of Laparoscopic Salpingotomy for Tubal Pregnancy

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タイトル: Re-evaluation of the Indication and Limitation of Laparoscopic Salpingotomy for Tubal Pregnancy
著者: Fujishita, Akira / Khan, Khaleque Newaz / Kitajima, Michio / Hiraki, Koichi / Miura, Seiyou / Ishimaru, Tadayuki / Masuzaki, Hideaki
発行日: 2008年 4月
出版者: Elsevier
引用: European Journal of Obstetrics & Gynecology and Reproductive Biology, 137(2), pp.210-216; 2008
抄録: Objective. We investigated the outcome of laparoscopic salpingotomy for tubal pregnancy by follow-up hysterosalpingography (HSG) or second look laparoscopy (SLL) and reexamined the indication and limitation of this conservative surgery. / Study Design. From April 1991 to December 2003, we treated one hundred and eighty one cases of tubal pregnancy by laparoscopic salpingotomy. The tubal patency was assessed by either HSG or SLL performed at three months post-surgery. The successful patients at initial operation and the confirmed ipsilateral patent tubes at follow-up were classified as true successful cases (Group I). Even after successful operation, if the treated tubes were found occluded, they were considered as failure cases. Therefore, unsuccessful cases at initial surgery as well as at follow-up were categorized as Group II. / Results. One hundred thirty four cases (74%) were successfully treated by salpingotomy at initial laparoscopy and also 85 of them (63.4%) were found truly successful at follow-up (Group I). The remaining 47 cases (26.0%) were unsuccessful at initial surgery and 18 (13.4%) cases at follow-up (Group II). Other patients who refused to accept a tubal patency test or not examined as a result of personal reason or lost follow-up comprised 31 cases. No difference in surgical outcome was observed with gestational age, intra-operative hemorrhage, size or anatomic location of pregnancy mass, and preoperative adhesions of the fallopian tube between these two groups of patients. However, pre-operative serum levels of hCG were significantly higher in Group II compared with Group I. In addition, the failure cases were more frequently associated with positive fetal heart beat (FHB), tubal rupture and a preoperative serum levels of hCG of more than 10,000 IU/L (p<0.05, χ2 test). The Log-rank test indicated a higher success in achieving pregnancy in Group I (p<0.05) than in Group II who desired for future pregnancy. / Conclusion. Laparoscopic salpingotomy can be equally practiced as a conservative surgery for also proximal ectopic pregnancy and gestational mass size is not so much important and not a relative contraindication for conservative laparoscopic surgery as previously reported. Low preoperative hCG levels, absence of FHB, absence of tubal rupture initially or minimal rupture may be considered as suitable parameters for successful surgery and achieving future pregnancy.
記述: Without Figures and Tables
キーワード: ectopic pregnancy / laparoscopy / linear salpingotomy / pregnancy outcome
URI: http://hdl.handle.net/10069/16400
ISSN: 03012115
DOI: 10.1016/j.ejogrb.2007.01.016
PubMed ID: 17459564
権利: Copyright © 2007 Elsevier Ireland Ltd All rights reserved.
資料タイプ: Journal Article
原稿種類: author
出現コレクション:130 学術雑誌論文

引用URI : http://hdl.handle.net/10069/16400



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