Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, Australia.
QIMR Berghofer Medical Research Institute, Herston, Australia.
J Obstet Gynaecol. 2021 Oct;41(7):1097-1101. doi: 10.1080/01443615.2020.1821620. Epub 2020 Nov 28.
This 5-year retrospective study aimed to investigate whether early surgical management improves outcomes in patients presenting with a tubo-ovarian abscess (TOA). Patient characteristics, investigation results and treatment outcomes were compared. 50 women were diagnosed with a TOA during the study period. Nineteen (38.0%) were treated with antibiotics (medical group) and thirty one (62.0%) were treated surgically on admission (early surgical group). The early surgical group was associated with a high success rate of 96.8% and the lowest risk of readmission within 12 months (16.1%). There was no significant difference in the length of stay between the early surgical and the successful medical group.Impact Statement Tubo-ovarian abscess (TOA) is an inflammatory mass that forms most commonly as a complication of untreated pelvic inflammatory disease (PID). Traditionally, TOAs are treated first with broad-spectrum intra-venous antibiotics, with surgical intervention considered after 72 h. It is not known whether early surgical intervention would be beneficial to patient outcomes compared to traditional management. In this study, we have demonstrated a high success rate with early surgical management. Readmission rate was lowest in the early surgical group compared to the medical and late surgical group. This suggests that early surgical intervention may be beneficial, compared to the standard management of trialling antibiotics and then proceeding to surgery 72 h later. Our study suggests that early surgery may be beneficial in the management of TOAs. Although we were unable to demonstrate statistical significance, our data suggest that it would be worthwhile to investigate white blood cell (WBC) and C-reactive protein (CRP) further as a potential predictor for failure of medical management. In the future, more studies comparing early surgical management with medical and late surgical management could inform clinicians of the best mode of treatment for these patients.
这项为期 5 年的回顾性研究旨在探讨早期手术治疗是否能改善输卵管卵巢脓肿（TOA）患者的预后。比较了患者特征、检查结果和治疗结果。研究期间，50 名女性被诊断为 TOA。19 名（38.0%）接受抗生素治疗（医疗组），31 名（62.0%）入院时接受手术治疗（早期手术组）。早期手术组的成功率为 96.8%，12 个月内再入院风险最低（16.1%）。早期手术组和成功的药物治疗组的住院时间无显著差异。
输卵管卵巢脓肿（TOA）是一种炎症性肿块，最常见于未经治疗的盆腔炎（PID）的并发症。传统上，TOA 首先用广谱静脉内抗生素治疗，72 小时后再考虑手术干预。与传统治疗相比，早期手术干预是否对患者结局有益尚不清楚。在这项研究中，我们证明了早期手术治疗的高成功率。与药物治疗组和晚期手术组相比，早期手术组的再入院率最低。这表明与标准的抗生素治疗方案（先尝试抗生素治疗，72 小时后再进行手术）相比，早期手术干预可能是有益的。
我们的研究表明，早期手术可能对 TOA 的治疗有益。尽管我们未能证明统计学意义，但我们的数据表明，进一步研究白细胞（WBC）和 C 反应蛋白（CRP）作为药物治疗失败的潜在预测指标是值得的。未来，比较早期手术治疗与药物治疗和晚期手术治疗的更多研究可以为这些患者的最佳治疗模式提供信息。
