Virginia Mason Medical Center, Department of Gynecology, Seattle, Washington, USA.
Curr Opin Obstet Gynecol. 2021 Aug 1;33(4):249-254. doi: 10.1097/GCO.0000000000000720.
The purpose of this publication is to review the most up-to-date literature regarding the pathogenesis, diagnosis and management of tubo-ovarian abscesses.
Prior to the advent of broad-spectrum antibiotics, tubo-ovarian abscesses necessitated total abdominal hysterectomy and bilateral salpingo-oophorectomy. Although it carries a risk of treatment failure, antibiotic therapy enabled fertility-sparing treatment for many women. Recent studies have identified key predictors for antibiotic treatment failure, including age, BMI and abscess diameter. C-reactive protein was also found to be a strong predictor of antibiotic treatment response. Given the growing evidence of treatment failure with antibiotic therapy alone, along with increased availability and access to interventional radiology, image-guided drainage with or without catheter placement, combined with broad-spectrum antibiotics, is now considered first-line therapy.
Tubo-ovarian abscess is a diagnostic challenge, as presentation can vary. Inadequate treatment is associated with severe morbidity and mortality. Despite adequate conservative treatment, recurrence risk is high and clinical sequelae can have devastating effects on reproductive health. Recent evidence-based developments, including a risk score system to predict antibiotic failure, serve to provide appropriately directed risk-based care. However, large-scale randomized controlled trials are needed to clarify the most appropriate treatment modalities.
本文旨在综述关于输卵管卵巢脓肿的发病机制、诊断和处理的最新文献。
在广谱抗生素问世之前，输卵管卵巢脓肿需要进行全子宫切除术和双侧输卵管卵巢切除术。尽管其存在治疗失败的风险，但抗生素治疗使许多妇女能够保留生育能力。最近的研究确定了抗生素治疗失败的关键预测因素，包括年龄、BMI 和脓肿直径。C 反应蛋白也被发现是抗生素治疗反应的一个强有力的预测指标。鉴于单独使用抗生素治疗的失败率不断增加，以及介入放射学的可用性和可及性增加，在广泛使用抗生素的同时，进行影像学引导下的引流术，或联合使用导管，已被认为是一线治疗方法。
输卵管卵巢脓肿的诊断具有挑战性，因为其表现可能多种多样。治疗不充分与严重的发病率和死亡率相关。尽管进行了适当的保守治疗，复发风险仍然很高，临床后遗症可能对生殖健康产生毁灭性影响。最近基于证据的发展，包括预测抗生素失败的风险评分系统，有助于提供基于风险的适当治疗。然而，需要进行大规模的随机对照试验来明确最适当的治疗方式。
