腹腔镜下保守手术及根治手术治疗输卵管妊娠生育结局的Meta分析  

Fertility Outcome after Laparoscopic Conservative Surgery and Radical Surgery for Tubal Pregnancy: A Meta-Analysis

作　　者：黄启涛[1] 李银[2] 陈夏珠[2] 梁伟璋[1] 张敏[1] 钟梅[1] 

机构地区：[1]南方医科大学南方医院,广东广州510515 [2]南方医科大学第一临床医学院,广东广州510515

出　　处：《实用妇产科杂志》2013年第10期757-761,共5页Journal of Practical Obstetrics and Gynecology

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.

关 键 词：腹腔镜 保守手术 根治手术 输卵管妊娠 

分 类 号：R714.22[医药卫生—妇产科学]