| Backgrounds and objections:Tubal pregnancy refers to the zygote implants in the fallopian tube.It is the most common type of ectopic pregnancy, and the incidence oftubal pregnancy is increasing in recent years. As the high sensitivity ofradioimmunoassay blood HCG. The popularization of TVU andapplication of laparoscopy in the diagnosis and treatment of tubepregnancy, early diagnosis and treatment of tube pregnancy have a leapdevelopment and progress.Due to tubal pregnancy is common in childbearing age women, thebirth outcome after treatment gets more and more attention by the patientsand their families. How to make it possible to keep the fertility during thetreatment and how to increase the rate of IUP become urgent problemsthat need the doctor to solve as soon as possible.In recent years, as the progress of the laparoscopic instruments, thepopularity of laparoscopic technology, its were more and more widelyapplication in gynecologic surgery. Because of the laparoscopy getssmaller wound, less bleeding, faster recovery and much less disturbanceof the abdominal organs than laparotomy. It has become the preferredchoice for tubal pregnancy. According to whether keep patients ‘tube,wecan divide laparoscopy into: laparoscopic salpingectomy and laparoscopicconservative surgery. Clinically, it has been controversial that two kindsof laparoscopic operation which is more advantageous to intrauterinepregnancy.Research Methods:Searching the PubMed,MEDLINE,CNKI., wanfang database,VIPdatabase, etc. According to include and exclude standards, eventually there are11group study about laparoscopic salpingectomy andconservative surgery on postoperative intrauterine pregnancy, includinglaparoscopic salpingectomy:679cases, laparoscopic conservative surgerygroup:1038. There are10report about laparoscopic salpingectomy andconservative surgery postoperative ectopic pregnancies, includinglaparoscopic salpingectomy:795cases, laparoscopic conservative surgerygroup:1117. There are8report about laparoscopic tubal fenestration andsalpingectomy on postoperative intrauterine pregnancy, includinglaparoscopic salpingectomy:677cases, laparoscopic tubal fenestrationgroup:705. There are6report about laparoscopic tubal fenestration andsalpingectomy on postoperative ectopic pregnancies, includinglaparoscopic salpingectomy:430cases, laparoscopic tubal fenestrationgroup:514.Using the Review manager5.1software to accomplish Metaanalysis study.Results:1.Seen from the forest graph in figure4.2.1, the diamond is locatedin the left side of the center line completely, without intersecting line. Z=8.44(P <0.00001), so for the tubal pregnancy patients, laparoscopicconservative surgery postoperative intrauterine pregnancy rate is higherthan that of laparoscopic salpingectomy, OR=0.40(95%CI [0.32,0.57]).2.Seen from the forest graph in figure4.2.6the diamond is locatedin the left side of the center line completely, without intersecting line. Z=4.28(P<0.0001), so for the tubal pregnancy patients, laparoscopicconservative surgery postoperative repeat ectopic pregnancy rate is higherthan that of laparoscopic salpingectomy, OR=0.49,95%CI [0.36,0.68]). 3. Seen from the forest graph in figure4.2.11, the diamond islocated in the left side of the center line completely, without intersectingline. Z=4.46(P<0.00001), so for the tubal pregnancy patients,laparoscopic tubal fenestration postoperative intrauterine pregnancy rateis higher than that of laparoscopic salpingectomy, OR=0.61(95%CI[0.49,0.76])4. Seen from the forest graph in figure4.2.16the diamond islocated in the left side of the center line completely, without intersectingline. Z=2.35(P=0.02), so for the tubal pregnancy patients, laparoscopictubal fenestration postoperative repeat ectopic pregnancy rate is higherthan that of laparoscopic salpingectomy, OR=0.59,95%CI [0.38,0.92]).Conclusions:In recent years, with the progress of laparoscopic surgical instruments,increasing of surgical operator proficiency, reducing the interference toadjacent organs and the damage on fallopian tube in the process ofoperation, the rate of tubal pregnancy patients laparoscopic postoperativeIUP has a tendency to improve. The Meta-analysis based on tubalpregnancy cases come to the conclusion: the patients who undergolaparoscopic salpingectomy have lower spontaneous intrauterinepregnancy rate and lower repeat ectopic pregnancy rate than those whoundergo laparoscopic conservative surgery. The patients who undergolaparoscopic salpingectomy have lower spontaneous intrauterinepregnancy rate and lower repeat ectopic pregnancy rate than those whoundergo laparoscopic tubal fenestration.Consequently, tubal pregnancypatients with fertility requirements and indications for laparoscopicsurgery, should be suggested to undergo conservative surgery to improvethe chances of postoperative intrauterine pregnancy.However, patients without fertility requirements should be advised to go under laparoscopicsalpingectomy to avoid postoperative repeat ectopic pregnancy... |
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