Kumar Ramesh, Ranjan Alok, Narayan Ruchika, Priyadarshi Rajeev Nayan, Anand Utpal
Department of Gastroenterology, All India Institute of Medical Sciences, Patna, 801 507, India.
Department of Community and Family Medicine, All India Institute of Medical Sciences, Patna 801 507, India.
Indian J Gastroenterol. 2019 Dec;38(6):498-508. doi: 10.1007/s12664-019-01004-y. Epub 2020 Jan 21.
The role of metronidazole alone, percutaneous aspiration (PA), and percutaneous catheter drainage (PCD) in the treatment of uncomplicated amebic liver abscess (ALA) is still unclear. This systematic review and meta-analysis evaluated the available evidences with regard to treatment modalities in such patients.
The database was searched for relevant randomized controlled trials (RCTs) published until May 2019. All studies were assessed for risk of bias. The relevant data were pooled in a random or fixed-effect model to calculate the mean difference (MD) or relative risks.
After the detailed screening, 570 patients from 10 RCTs comparing metronidazole alone with metronidazole + PA were included. Most studies had uncertain risk of biases. Days to resolution of abdominal pain (MD - 1.59, 95% confidence interval [CI] - 2.77, - 0.42, I = 89%) and tenderness (MD - 1.76, 95% CI - 2.93, - 0.58, I = 72%) were significantly shorter in the metronidazole + PA group. There was no significant difference in relation to the resolution of fever, abscess size, and hospital stay. The beneficial effects of PA were seen with medium-to-large (> 5 cm) ALA and not with small (< 5 cm) ALA. Addition of PCD to metronidazole therapy was better than metronidazole alone in one low-quality RCT. Two RCTs found PCD to be better than PA for large ALA.
Percutaneous aspiration as compared with metronidazole alone results in the early resolution of pain and tenderness in patients with medium-to-large ALA. Percutaneous catheter drainage is better for larger ALA. However, discrepancies in RCTs create therapeutic dilemmas necessitating further efforts to generate more reliable data.
甲硝唑单药治疗、经皮穿刺抽吸（PA）及经皮导管引流（PCD）在单纯性阿米巴肝脓肿（ALA）治疗中的作用仍不明确。本系统评价和荟萃分析评估了此类患者治疗方式的现有证据。
检索数据库中截至2019年5月发表的相关随机对照试验（RCT）。对所有研究进行偏倚风险评估。将相关数据采用随机或固定效应模型合并，以计算平均差（MD）或相对风险。
经过详细筛选，纳入了10项比较甲硝唑单药与甲硝唑+PA的RCT中的570例患者。大多数研究的偏倚风险不确定。甲硝唑+PA组腹痛缓解天数（MD -1.59，95%置信区间[CI] -2.77，-0.42，I² = 89%）和压痛缓解天数（MD -1.76，95%CI -2.93，-0.58，I² = 72%）显著缩短。在发热缓解、脓肿大小及住院时间方面无显著差异。PA的有益作用在中至大（>5 cm）ALA患者中可见，而在小（<5 cm）ALA患者中未见。在一项低质量RCT中，甲硝唑治疗加用PCD优于单用甲硝唑。两项RCT发现，对于大ALA，PCD优于PA。
与单用甲硝唑相比，经皮穿刺抽吸可使中至大ALA患者的疼痛和压痛更早缓解。对于更大的ALA，经皮导管引流效果更好。然而，RCT中的差异造成了治疗困境，需要进一步努力以产生更可靠的数据。
