Interventions for tubal ectopic pregnancy

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Abstract
Treatment options for tubal ectopic pregnancy are; (1) surgery, e.g. salpingectomy or salpingo(s)tomy, either performed laparoscopically or by open surgery; (2) medical treatment, with a variety of drugs, that can be administered systemically and/or locally by various routes and (3) expectant management. To evaluate the effectiveness and safety of surgery, medical treatment and expectant management of tubal ectopic pregnancy in view of primary treatment success, tubal preservation and future fertility. We searched the Cochrane Menstrual Disorders and Subfertility Group's Specialised Register, Cochrane Controlled Trials Register (up to February 2006), Current Controlled Trials Register (up to October 2006), and MEDLINE (up to October 2006). Randomized controlled trials (RCTs) comparing treatments in women with tubal ectopic pregnancy. Two review authors independently extracted data and assessed quality. Differences were resolved by discussion with all review authors. Thirty five studies have been analyzed on the treatment of tubal ectopic pregnancy, describing 25 different comparisons. Surgery Laparoscopic salpingostomy is significantly less successful than the open surgical approach in the elimination of tubal ectopic pregnancy (2 RCTs, n = 165, OR 0.28, 95% confidence interval (CI) 0.09 to 0.86) due to a significant higher persistent trophoblast rate in laparoscopic surgery (OR 3.5, 95% CI 1.1 to 11). However, the laparoscopic approach is significantly less costly than open surgery (P = 0.03). Long term follow up (n = 127) shows no evidence of a difference in intra uterine pregnancy rate (OR 1.2, 95% CI 0.59 to 2.5) but there is a non significant tendency to a lower repeat ectopic pregnancy rate (OR 0.47, 95% 0.15 to 1.5). Medical treatment Systemic methotrexate in a fixed multiple dose intramuscular regimen has a non significant tendency to a higher treatment success than laparoscopic salpingostomy (1 RCT, n = 100, OR 1.8, 95% CI 0.73 to 4.6). No significant differences are found in long term follow up (n=74): intra uterine pregnancy (OR 0.82, 95% CI 0.32 to 2.1) and repeat ectopic pregnancy (OR 0.87, 95% CI 0.19 to 4.1). Expectant management Expectant management is significantly less successful than prostaglandin therapy (1 RCT, n = 23, OR 0.08, 95% CI 0.02 to 0.39). In the surgical treatment of tubal ectopic pregnancy laparoscopic surgery is a cost effective treatment. An alternative non surgical treatment option in selected patients is medical treatment with systemic methotrexate. Expectant management can not be adequately evaluated yet. 輸卵管異位妊娠之介入性治療 輸卵管異位妊娠之治療選擇包括： (1) 手術，如，輸卵管切除術或輸卵管造口術，其可由腹腔鏡手術或開腹手術進行； (2) 藥物治療，使用各種不同之藥物，其可由各種不同之途徑進行全身性及/或局部性之投與；以及 (3) 期待療法。 針對治療之成功率、輸卵管之保留，以及未來之生育力，評估手術、藥物治療與期待療法對於輸卵管異位妊娠之有效性及安全性。 我們搜尋 Cochrane Menstrual Disorders以及Subfertility Group's Specialised Register、Cochrane Controlled Trials Register (直到2006年2月) 、Current Controlled Trials Register (直到2006年10月) ，以及MEDLINE (直到2006年10月) 。 針對輸卵管異位妊娠婦女之治療進行比較之隨機對照試驗 (Randomized controlled trials；RCTs) 。 由2位回顧作者獨立摘錄數據並評估品質。意見差異由所有回顧作者討論解決。 針對輸卵管異位妊娠之治療，共分析了35項研究，其中述及25種不同之比較。就移除輸卵管異位妊娠而言，由腹腔鏡手術進行之輸卵管造口術顯著不如由開腹手術方式進行者成功 (2 RCTs, n = 165, OR 0.28, 95% 信賴區間 (confidence interval；CI) 0.09 – 0.86) ，因為腹腔鏡手術具有顯著較高之持續性異位妊娠率 (OR 3.5, 95% CI 1.1 – 11) 。然而，腹腔鏡方法之成本顯著低於開腹手術 (P = 0.03) 。長期之追蹤 (n = 127) 顯示，並無證據說明其子宮內懷孕率具有差異 (OR 1.2, 95% CI 0.59 – 2.5) ，但其具有非顯著性傾向之較低重複異位妊娠率 (OR 0.47, 95% 0.15 – 1.5) 。藥物治療：相較於腹腔鏡之輸卵管造口術，以固定多劑肌內療程全身性投與之methotrexate治療具有非顯著性但傾向較高的治療成功率 (1 RCT, n = 100, OR 1.8, 95% CI 0.73 −4.6) 。在長期追蹤資料 (n = 74) ，並未發現下列方面之顯著差異：子宮內懷孕率 (OR 0.82, 95% CI 0.32 – 2.1) 以及重複異位妊娠率 (OR 0.87, 95% CI 0.19 – 4.1) 。期待療法︰期待療法顯著不如前列腺素治療成功 (1 RCT, n = 23, OR 0.08, 95% CI 0.02 −0.39) 。 在輸卵管異位妊娠之手術治療中，腹腔鏡手術係高成本效益之治療。針對特定病患之替代性，非手術治療選擇為使用全身性投與之methotrexate進行藥物治療。期待療法尚無法獲得適當評估。 此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。 輸卵管異位妊娠之介入性治療。約有1%...