Obstetrics & Gynecology and Women's Health Institute, Cleveland Clinic Foundation (Drs. Goje and Kollikonda).
Cleveland Clinic Lerner College of Medicine, Case Western Reserve University (Ms. Markwei).
J Minim Invasive Gynecol. 2021 Mar;28(3):556-564. doi: 10.1016/j.jmig.2020.09.014. Epub 2020 Sep 28.
To compare the success rate, complications, and hospital length-of-stay of 3 modalities of minimally invasive management of tubo-ovarian abscesses (TOAs): laparoscopy, ultrasound-guided drainage, and computed tomography-guided drainage.
Electronic-based search in PubMed, EMBASE, Ovid MEDLINE, Google Scholar, and Cochrane Central Register of Controlled Trials, using the following Medical Subject Heading terms: "minimally invasive surgical procedures," "drainage," "abscess," "tubo-ovarian," "ovarian diseases," and "fallopian tube diseases."
Of the 831 articles in the initial results, 10 studies were eligible for inclusion in our systematic review.
TABULATION, INTEGRATION, AND RESULTS: A total of 975 patients were included in our study; 107 (11%) had laparoscopic drainage procedures, and 406 (42%) had image-guided (ultrasound or computed tomography) drainage of TOAs. Image-guided TOA drainage had higher success rates (90%-100%) than laparoscopic drainage (89%-96%) and the use of antibiotic treatment alone (65%-83%). Patients treated with image-guided drainage had no complications (for up to 6 months of follow-up) and shorter lengths of hospital stay (0-3 days on average) compared with laparoscopic drainage (5-12 days) or conservative management with antibiotics alone (7-9 days).
Although conservative management of TOAs with antibiotics alone remains first-line, our review indicates that better outcomes in the management of TOA were achieved by minimally invasive approach compared with conservative treatment with antibiotics only. Of the minimally invasive techniques, image-guided drainage of TOAs provided the highest success rates, the fewest complications, and the shortest hospital stays compared with laparoscopy. The low magnitude of evidence in the included studies calls for further randomized trials. This systematic review was registered in the International Prospective Register of Systematic Review (register, http://www.crd.york.ac.uk/PROSPERO;CRD 42020170345).
比较经腹腔镜、超声引导下引流和 CT 引导下引流 3 种微创治疗输卵管卵巢脓肿（TOA）方法的成功率、并发症和住院时间。
在 PubMed、EMBASE、Ovid MEDLINE、Google Scholar 和 Cochrane 对照试验中心注册处进行电子检索，使用以下医学主题词：“微创外科手术”、“引流”、“脓肿”、“输卵管卵巢”、“卵巢疾病”和“输卵管疾病”。
在最初的 831 篇文章中，有 10 项研究符合我们的系统评价纳入标准。
列表、整合和结果：共有 975 例患者纳入本研究；107 例（11%）患者行腹腔镜引流术，406 例（42%）患者行 TOA 影像引导（超声或 CT）引流术。影像引导 TOA 引流的成功率（90%-100%）高于腹腔镜引流（89%-96%）和单独使用抗生素治疗（65%-83%）。与腹腔镜引流（5-12 天）或单独使用抗生素的保守治疗（7-9 天）相比，接受影像引导引流的患者无并发症（随访 6 个月内），住院时间更短（平均 0-3 天）。
尽管单独使用抗生素治疗 TOAs 的保守治疗仍是一线治疗方法，但我们的综述表明，与单独使用抗生素的保守治疗相比，微创方法在治疗 TOA 方面取得了更好的结果。在微创技术中，与腹腔镜相比，TOA 的影像引导引流具有更高的成功率、更少的并发症和更短的住院时间。纳入研究的证据量较低，需要进一步的随机试验。本系统评价已在国际前瞻性系统评价注册库（http://www.crd.york.ac.uk/PROSPERO；CRD42020170345）注册。
