抄録
Objective: Conservative laparoscopic surgery has been performed for the preservation of fertility. However, this procedure is associated with the disadvantage of persistent chorionic villus (persistent ectopic pregnancy [PEP]). We examined whether PEP could be diagnosed early based on the transition of pre- and postoperative serum human chorionic gonadotropin (hCG) levels and the outcomes of PEP patients.
Methods: The subjects were 265 patients who underwent laparoscopic surgery for tubal pregnancy during the period between April 2005 and March 2014. Their serum hCG values were, in principle, measured before and at 1-2, 3, 7, and 14 days after surgery. We created a standard decay curve using the mean serum hCG ratios, as calculated by dividing the postoperative by the preoperative hCG values, in patients with radical surgery. We compared patients successfully treated by conservative tubal surgery and those with PEP.
Results: Among 265 patients, 153 underwent radical surgery, the other 112 conservative surgery. Among the patients receiving conservative surgery, 24 (21.4%) were diagnosed with PEP. Among these 24 patients, 21 concomitantly received intramuscular administration of methotrexate (MTX) 50 mg, and 5 underwent salpingectomy. The decay curve of the serum hCG ratios after radical surgery was given by y = 1.7704 × -2.16 (R2 = 0.74625). In patients successfully treated by conservative surgery, the postoperative serum hCG ratio showed nearly the same transition as the decay curve. In 8 patients (33.3%) among those with PEP, which was the largest number, the ratio was lower than the decay curve for 2 days after surgery and then showed an increase 3 days after surgery. In 4 patients (16.7%), the ratio showed an increase 14 or more days after surgery. To predict PEP in the early postoperative period, we compared the initial serum hCG ratios measured after surgery and found that the ratio in patients successfully treated by conservative surgery (0.427 ± 0.153) was significantly lower than that in patients with PEP (0.576 ± 0.186) (p < .0001). Analysis with ROC, initial serum hCG ratio 0.509 as cut-off revealed that the specifity was 79.3% and the sensitivity was 66.7%. In 11 patients (78.6%) among the 14 with PEP who underwent hysterosalpingography, tubal patency was observed.
Conclusion: The initial measurement of serum hCG ratios after surgery is considered to be useful for predicting PEP. However, careful follow-up is required because the hCG levels increase more than 2 weeks after surgery in some cases. Tubal patency was also suggested to be maintained relatively favorably with the additional administration of MTX even in patients with PEP.
