da Luz Moreira Andre, Stocchi Luca, Tan Emile, Tekkis Paris P, Fazio Victor W
Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Dis Colon Rectum. 2009 May;52(5):906-12. doi: 10.1007/DCR.0b013e31819f27c3.
The aim of this study was to evaluate clinical outcomes, quality-adjusted life-years, and the cost-effectiveness gained from percutaneous drainage followed by elective surgery vs. initial surgery for abdominopelvic abscesses related to Crohn's disease.
All consecutive patients with spontaneous Crohn's disease-related abdominopelvic abscess from 1997 to 2007 were reviewed. The authors excluded postoperative and perirectal abscesses. Decision analysis during one year of patient life was used to calculate quality-adjusted life-years and the cost-effectiveness of each strategy.
Of 94 patients, 48 (51 percent) were initially approached with percutaneous drainage. Thirty-one (65 percent) had successful percutaneous drainage and delayed elective surgery. The factors significantly associated with percutaneous drainage failure were steroid use, colonic phenotype, and multiple or multilocular abscesses. The initial treatment was surgery in the remaining 46 (49 percent) patients. The initial approach with percutaneous drainage gave higher quality-adjusted life-years and was more cost-effective than initial surgery. Percutaneous drainage was the optimal strategy in spite of the risk of failure and septic complications within the plausible range.
Percutaneous drainage failure is associated with steroid use, colonic phenotype, and multiple or multilocular abscesses. When feasible, percutaneous drainage is the most effective strategy from the perspective of patients and third-party payers.
本研究旨在评估经皮引流后择期手术与初始手术治疗克罗恩病相关腹盆腔脓肿的临床结局、质量调整生命年以及成本效益。
回顾了1997年至2007年所有连续性自发性克罗恩病相关腹盆腔脓肿患者。作者排除了术后脓肿和直肠周围脓肿。采用患者生命1年内的决策分析来计算质量调整生命年和每种策略的成本效益。
94例患者中，48例（51%）最初采用经皮引流。31例（65%）经皮引流成功并延迟择期手术。与经皮引流失败显著相关的因素是使用类固醇、结肠表型以及多发或多房脓肿。其余46例（49%）患者初始治疗为手术。与初始手术相比，初始采用经皮引流可获得更高的质量调整生命年且更具成本效益。尽管在合理范围内存在失败和感染并发症风险，但经皮引流仍是最佳策略。
经皮引流失败与使用类固醇、结肠表型以及多发或多房脓肿相关。在可行的情况下，从患者和第三方支付者的角度来看，经皮引流是最有效的策略。
