Service d'ORL et de chirurgie cervico-faciale, CHU de toulouse, hôpital Larrey, 24, chemin de Pouvourville, TSA 30030, 31059, Toulouse cedex 9, France.
Service d'épidémiologie, CHU de Toulouse, 31000, Toulouse, France.
Eur Arch Otorhinolaryngol. 2019 Sep;276(9):2595-2601. doi: 10.1007/s00405-019-05542-1. Epub 2019 Jul 12.
The treatment of peritonsillar abscess (PTA) is still controversial regarding the best method of drainage to perform. This study aims to compare effectiveness and safety of needle aspiration versus incision and drainage under local anaesthesia for the initial treatment of PTA.
A retrospective review of patients (age > 15 years) admitted in two tertiary medical centres for a PTA between November 2010 and October 2016 was performed. Patients were divided into two groups according to the type of drainage: needle aspiration or incision and drainage, under local anaesthesia. The primary outcome was the length of hospital stay; the need to repeat the procedure or to go to the operating room was also assessed. Complications or adverse events were listed in each group to assess safety.
Over a 6-year period, 182 patients were admitted for a PTA and included in the analysis, with 82 patients in the aspiration group and 100 patients in the incision group. Mean age was 36.3 years, with a sex ratio of 1.33. The length of hospital stay ranged from 1 to 7 days (mean 2.7 days, median 2 days) with a median length of stay of 3.0 days (interquartile range 2-4) in the aspiration group versus 2.0 days (IQR 2-3) in patients who underwent incision and drainage (p = 0.009). A repetition of the needle aspiration was made for 46.3% of patients versus 10% of repetition of the procedure in the incision group (p = 0.0001). 12 patients (14%) of the aspiration group and 4 patients (4%) of the incision group required an additional drainage under general anaesthesia (p < 0.001). We found no differences regarding safety in both groups.
Our study showed a significant decrease in the length of hospital stay in patients admitted for a PTA who underwent an initial incision and drainage under local anaesthesia, compared to needle aspiration, as well as a lower risk of repeating the procedure. A well-designed prospective and randomized study on a larger sample of patients is required to support these findings.
关于扁桃体周脓肿（PTA）的治疗，目前仍存在最佳引流方法的争议。本研究旨在比较局部麻醉下经皮穿刺抽脓与切开引流术治疗 PTA 的有效性和安全性。
回顾性分析 2010 年 11 月至 2016 年 10 月期间在两家三级医疗中心因 PTA 住院的患者（年龄＞15 岁）。根据引流方式（局部麻醉下经皮穿刺抽脓或切开引流术）将患者分为两组。主要结局为住院时间；还评估了需要重复该操作或转至手术室的情况。列出每组的并发症或不良事件以评估安全性。
在 6 年期间，共 182 例患者因 PTA 入院并纳入分析，其中经皮穿刺抽脓组 82 例，切开引流组 100 例。患者平均年龄为 36.3 岁，男女比例为 1.33。住院时间为 1 至 7 天（平均 2.7 天，中位数 2 天），经皮穿刺抽脓组的中位住院时间为 3.0 天（四分位距 2-4），而切开引流组为 2.0 天（四分位距 2-3）（p=0.009）。经皮穿刺抽脓组中有 46.3%的患者需要重复操作，而切开引流组中有 10%的患者需要重复操作（p=0.0001）。经皮穿刺抽脓组中有 12 例（14%）和切开引流组中有 4 例（4%）患者需要在全身麻醉下进行额外引流（p＜0.001）。两组的安全性无差异。
与经皮穿刺抽脓相比，局部麻醉下初始切开引流术可显著缩短 PTA 患者的住院时间，并降低重复操作的风险。需要一项设计良好的、针对更大样本量患者的前瞻性随机研究来支持这些发现。
