抄録
Objective: We investigated the reproductive performance of women with a single fallopian tube after conservative laparoscopic surgery for a tubal pregnancy.
Study Design: From August 1992 through April 2010, we treated 300 hundred cases of tubal pregnancy with conservative laparoscopic surgery (salpingotomy). Tubal patency was assessed by either hysterosalpingography (HSG) or second-look laparoscopy (SLL) three months postoperatively. We confirmed pregnancy outcome by contacting all women by telephone and/or mail.
Results: Among 300 cases, 22 patients (7.4%) with a single fallopian tube underwent a laparoscopic salpingotomy for tubal pregnancy. Conservative surgery was successful in 14 of 22 cases (64%); eight cases were converted to a salpingectomy due to complete rupture of oviduct mucosa and continuous bleeding. No difference in surgical outcome was observed between the successful and unsuccessful cases in regard to gestational age, intraoperative hemorrhage, size and location of the pregnancy mass, and presence of fetal heart beat (FHB). However the unsuccessful cases were more frequently associated with higher pre-operative serum hCG levels than the successful cases (12,610±13,344 versus 3,604±3,045 IU/L; P < 0.05; χ2 test). In eleven of 14 successful cases, the postoperative serum hCG level gradually declined. However, the remaining three of 14 cases developed a persistent ectopic pregnancy (PEP). Among these three cases, two cases required an additional methotrexate (MTX) injection due to an inadequate decline in the serum hCG level and one case of PEP subsequently ruptured. Postoperative tubal patency was confirmed in 9 of 14 cases (HSG: 7 cases, SLL: 2 cases). Among 13 married women who desired a future pregnancy and were trying to achieve a pregnancy after the surgery, pregnancy was confirmed in 8 cases (62%).
Conclusions: A higher tubal patency rate and a satisfactory reproductive outcome were observed after conservative laparoscopic surgery for tubal pregnancy in women with a single fallopian tube. This report strengthens the clinical value of a laparoscopic salpingotomy for tubal pregnancy.
