To evaluate the safety, efficacy and subsequent fertility outcomes of modified tubal conservative operation in treatment of ampullary pregnancy.

From January 1, 2015 to June 31, 2016, a total of 70 cases of patients who were diagnosed as ampullary pregnancy in Shanghai Putuo Maternity and Infant Health Hospital were chosen as study subjects, and those 70 patients had fertility requirements to retain the fallopian tubes. According to random number table method, they were divided into study group (n=36, treated by modified tubal conservative operation) and control group (n=34, treated by laparoscopic salpingostomy). A retrospective analysis method was used to collect general clinical data of two groups, including age, gravidity, menopause days, etc., and to collect treatment status of two groups, including operation duration, intraoperative blood loss, incidence rates of persistent ectopic pregnancy (PEP) and intrauterine pregnancy at the 6th and 12th months after operation, recurrent ectopic pregnancy (REP) rate, and cure rate, etc.. The age, menopause days, preoperative blood β-human chorionic gonadotropin (hCG) levels, operation duration, and intraoperative blood loss of two groups were statistically compared by independent-samples t test. The gravidity and postoperative pain duration of two groups were statistically compared by Wilcoxon rank sum test. The incidence rates of intrauterine pregnancy, PEP, REP and cure rates of two groups were statistically compared by chi-square test. The proportions of different pain levels at the 3rd and 7th days after operation of two groups were statistically compared by Mann-Whitney U test. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Shanghai Putuo Maternity and Infant Health Hospital (Approval No. 2014-18). Informed consent was obtained from each participant.

① There were no significant differences between two groups in the age, gravidity, menopause days, and preoperative blood β-hCG levels (P>0.05). ② The operative duration of study group was (58.3±11.2) min, which was significantly longer than that of control group (30.1±10.7) min, and the difference was statistically significant (t=10.759, P<0.001). The intraoperative blood loss of study group was (35.2±6.3) mL, which was significantly higher than that of control group (20.4±5.6) mL, and the difference also was statistically significant (t=10.370, P<0.001). ③ There was no significant difference between two groups in the incidence rates of intrauterine pregnancy and REP at the 6th month after operation (P>0.05). Follow-up results at the 12th month after operation showed that the incidence rate of intrauterine pregnancy in study group was 25.0% (9/36), which was significantly higher than that of control group 5.9% (2/34), and the difference was statistically significant (χ²=4.825, P=0.028); however, there was no significant difference between two groups in the incidence rate of REP (χ²=2.802, P=0.094).

Modified tubal conservative operation for ampullary pregnancy has the advantage of higher intrauterine pregnancy rate than that of laparoscopic salpingostomy, but it has a longer operation duration and higher intraoperative blood loss.