宫外孕治疗方式与受孕几率
2013-06-04 22:42:47   来源：37度医学网   作者：  评论：0 点击：

首次随机调查将药物治疗与保守型手术以及保守型手术与激进型手术分别进行对比后发现，术后的生育能力并未有很大差异。研究对比了宫外孕的三种治疗方式：注射甲氨蝶呤以中断输卵管妊娠（药物治疗）、手术输卵管造口术（保守型手术）以及输卵管切除术（激进型手术）。研究刊登于欧洲顶尖生殖学期刊Human Reproduction。

　　文章来源：Human Reproduction

　　原文链接：http://humrep.oxfordjournals.org/content/early/2013/03/04/humrep.det037.full

　　原文：

　　Fertility after ectopic pregnancy: the DEMETER randomized trial

　　Author: Hervé Fernandez, Perrine Capmas, Jean Philippe Lucot, Benoit Resch, Pierre Panel, Jean Bouyer

　　Abstract

　　STUDY QUESTION Does treatment for the resolution of ectopic pregnancy (EP) affect subsequent spontaneous fertility [occurrence of an intrauterine pregnancy (IUP)]?

　　SUMMARY ANSWER There is no significant difference in 2 years subsequent fertility neither between methotrexate and conservative surgery for less active EP nor between conservative and radical surgery for the most active EP.

　　STUDY DESIGN, SIZE, DURATION This randomized controlled trial included all women with an ultrasound-confirmed EP. Women were divided into two arms according to the activity of the EP (defined by Fernandez's score). In arm 1 (less active ectopic pregnancies, i.e. Fernandez's score <13 and no haemodynamic failure), medical treatment was considered practicable, and women were randomly allocated to conservative surgery with a systematic post-operative i.m. methotrexate injection within 24 h or to an i.m. methotrexate injection alone. In arm 2 (active ectopic pregnancies), medical treatment was considered impracticable, and, thus, all women had to undergo surgery; they were randomly allocated to either a radical or conservative procedure, the latter including a post-operative methotrexate injection. Sample sizes (n = 210 in arm 1 and n = 230 in arm 2) were computed to provide a statistical power of 80% to detect a 20% difference in subsequent cumulative fertility rates between treatments in each arm. The total duration of the trial was 5 years.

　　MAIN RESULTS Arm 1: cumulative fertility curves were not significantly different between medical treatment and conservative surgery. HR was 0.85 (0.59–1.22) P = 0.37. The 2-year rates of IUP were 67% after medical treatment and 71% after conservative surgery. Arm 2: cumulative fertility curves were not significantly different between conservative and radical surgery. HR was 1.06 (0.69–1.63) P = 0.78. The 2-year rates of IUP were 70% after conservative surgery and 64% after radical surgery.