Buchweitz O, Malik E, Kressin P, Meyhoefer-Malik A, Diedrich K
Departement of Gynaecology and Obstetrics, University of Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany.
Surg Endosc. 2000 Oct;14(10):948-50. doi: 10.1007/s004640000249.
The laparoscopic management of tubo-ovarian abscesses (TOA) was evaluated. The study sought to answer the following question: Does operative laparoscopy with only incision of the abscess cavity and lavage (organ-preserving treatment) improve intraoperative and postoperative safety and long-term prospects of fertility as compared with laparoscopic salpingectomy or salpingo-oophorectomy (ablative treatment)?
A retrospective chart review of 60 patients with TOA undergoing laparoscopic treatment in combination with broad-spectrum antibiotics from 1994 to 1998 was performed. Patients not wishing to have children underwent salpingectomy or salpingo-oophorectomy, whereas patients wishing to remain fertile were treated by means of an organ-preserving procedure. To investigate the operative and reproductive outcome, patients were interviewed by telephone.
Of 60 women with TOA, 25 were treated laparoscopically, preserving the internal genital organs, and 35 underwent ablative treatment. Apart from one postoperative readmission because of lower pelvic pain in the organ-preserving group, there were no operative complications or serious systemic sequelae. In contrast, there was a significantly higher incidence of intraoperative and postoperative complications when ablative treatment was performed: one intestinal perforation requiring subsequent laparotomy, four serosal lesions, two lesions of the greater omentum, two lacerated collaterals of the internal iliac artery, one postoperative fever higher than 38 degrees C for 2 days, two bowel obstructions, one thrombosis of the upper leg, and one thrombosis of the lower leg. There were no significant differences between the two patient groups in body mass index, duration of pelvic pain, laboratory findings at admission, ultrasonic assessment of abscess size, and the extent of the abscess at laparoscopy.
When laparoscopic treatment of TOA is performed, organ-preserving treatment should be chosen irrespective of the patient's age or desire to have children because of the risk of complications.
对输卵管卵巢脓肿（TOA）的腹腔镜治疗进行评估。该研究试图回答以下问题：与腹腔镜输卵管切除术或输卵管卵巢切除术（切除性治疗）相比，仅切开脓肿腔并冲洗的手术腹腔镜检查（保留器官治疗）是否能提高术中及术后安全性以及生育的长期前景？
对1994年至1998年间60例接受腹腔镜治疗并联合使用广谱抗生素的TOA患者进行回顾性病历审查。不希望生育的患者接受输卵管切除术或输卵管卵巢切除术，而希望保持生育能力的患者则采用保留器官的手术进行治疗。为调查手术和生殖结果，通过电话对患者进行了访谈。
60例TOA女性患者中，25例接受了保留内生殖器器官的腹腔镜治疗，35例接受了切除性治疗。除保留器官组有1例因下腹部疼痛术后再次入院外，无手术并发症或严重的全身后遗症。相比之下，进行切除性治疗时，术中及术后并发症的发生率明显更高：1例肠穿孔需后续开腹手术，4例浆膜损伤，2例大网膜损伤，2例髂内动脉侧支撕裂，1例术后发热超过38摄氏度持续2天，2例肠梗阻，1例大腿血栓形成，1例小腿血栓形成。两组患者在体重指数、盆腔疼痛持续时间、入院时实验室检查结果、脓肿大小的超声评估以及腹腔镜检查时脓肿范围方面无显著差异。
进行TOA的腹腔镜治疗时，由于存在并发症风险，无论患者年龄或生育意愿如何，均应选择保留器官治疗。
