Jiang Xiaofei, Shi Mingqing, Sui Miao, Wang Tao, Yang Haiyan, Zhou Huifang, Zhao Kai
Department of Gynecology, Xuzhou City Hospital of Chinese Medicine, Xuzhou, Jiangsu 221003, P.R. China.
Department of Obstetrics and Gynecology, Lishui Hospital of Chinese Medicine, Lishui, Zhejiang 323000, P.R. China.
Exp Ther Med. 2019 Aug;18(2):1115-1122. doi: 10.3892/etm.2019.7699. Epub 2019 Jun 21.
Broad-spectrum antibiotics are the conservative treatment for tubo-ovarian abscess (TOA) or pelvic abscess, but the failure rate of antibiotic therapy remains higher in patients with a larger abscess. The present study aimed to evaluate the clinical value of early laparoscopic therapy in the management of TOA or pelvic abscess. A total of 100 patients were enrolled and their medical records were retrospectively analyzed after excluding 6 patients with malignant diseases. Based on the treatment they had received, the patients were divided into a conservative treatment group (n=41) and an early laparoscopic treatment group (n=53). In the conservative treatment group, 21 patients (51.2%) finally received laparoscopic exploration (late laparoscopic treatment group), and 20 patients (48.8%) achieved a success of antibiotic therapy (successful antibiotic therapy group). The cut-off value of abscess size for predicting antibiotic treatment failure was determined using receiver operating characteristic curve analysis. Multivariate logistic regression analyses were used to explore the association between the clinical variables and antibiotic therapy failure in conservative treatment group. The durations of elevated temperature >38.0°C and hospitalization were significantly longer in the conservative treatment group than those in the early laparoscopic treatment group (all P<0.001). The patients in the late laparoscopic treatment group had a larger abscess size than those in the successful antibiotic therapy group (6.2±1.8 cm vs. 4.8±1.4 cm, P=0.008). An abscess diameter of 5.5 cm was obtained as the cut-off of antibiotic failure, and the sensitivity and specificity were 81.0 and 85.0%, respectively. An abscess diameter of ≥5.5 cm was independently associated with antibiotic failure (odds ratio=5.724; 95%CI: 2.025-16.182; P=0.001). In conclusion, early laparoscopic treatment was associated with a better clinical prognosis than conservative treatment and late laparoscopic therapy for TOA or pelvic abscess patients.
广谱抗生素是输卵管卵巢脓肿（TOA）或盆腔脓肿的保守治疗方法，但对于脓肿较大的患者，抗生素治疗的失败率仍然较高。本研究旨在评估早期腹腔镜治疗在TOA或盆腔脓肿管理中的临床价值。共纳入100例患者，排除6例恶性疾病患者后对其病历进行回顾性分析。根据患者接受的治疗，将其分为保守治疗组（n = 41）和早期腹腔镜治疗组（n = 53）。在保守治疗组中，21例患者（51.2%）最终接受了腹腔镜探查（晚期腹腔镜治疗组），20例患者（48.8%）抗生素治疗成功（抗生素治疗成功组）。使用受试者工作特征曲线分析确定预测抗生素治疗失败的脓肿大小临界值。采用多因素logistic回归分析探讨保守治疗组临床变量与抗生素治疗失败之间的关联。保守治疗组体温>38.0°C持续时间和住院时间均显著长于早期腹腔镜治疗组（均P<0.001）。晚期腹腔镜治疗组患者的脓肿大小大于抗生素治疗成功组（6.2±1.8 cm对4.8±1.4 cm，P = 0.008）。得出脓肿直径5.5 cm为抗生素治疗失败的临界值，敏感性和特异性分别为81.0%和85.0%。脓肿直径≥5.5 cm与抗生素治疗失败独立相关（比值比=5.724；95%可信区间：2.025 - 16.182；P = 0.001）。总之，对于TOA或盆腔脓肿患者，早期腹腔镜治疗比保守治疗和晚期腹腔镜治疗具有更好的临床预后。
