University of Minnesota Medical School, Minneapolis, Minnesota, USA.
University of Minnesota School of Public Health, Minneapolis, Minnesota, USA.
Surg Infect (Larchmt). 2022 Jun;23(5):417-429. doi: 10.1089/sur.2022.072. Epub 2022 May 24.
Splenic abscess (SA) is a rare, life-threatening illness that is generally treated with splenectomy. However, this is associated with high mortality and morbidity. Recently, percutaneous drainage (PD) has emerged as an alternative therapy in select patients. In this study, we compare mortality and complications in patients with SA treated with splenectomy versus PD. A systematic literature search of 13 databases and online search engines was conducted from 2019 to 2020. A bivariate generalized linear mixed model (BGLMM) was used to conduct a separate meta-analysis for both mortality and complications. We used the risk of bias in non-randomized studies of interventions (ROBINS-I) tool to evaluate risk of bias in non-randomized studies, and the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach for assessing quality of evidence and strength of recommendations. Results were presented according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The review included 46 retrospective studies from 21 countries. For mortality rate, 27 studies compared splenectomy and PD whereas 10 used PD only and nine used splenectomy only. Data for major complications were available in 18 two-arm studies, seven single-arm studies with PD, and seven single-arm studies with splenectomy. Of a total of 589 patients, 288 were treated with splenectomy and 301 underwent PD. Mortality rate was 12% (95% confidence interval [CI], 8%-17%) in patients undergoing splenectomy compared with 8% (95% CI, 4%-13%) with PD. Complication rates were 26% (95% CI, 16%-37%) in the splenectomy group compared with 10% (95% CI, 4%-17%) in the PD group. Percutaneous drainage s associated with a trend toward lower complications and mortality rates compared with splenectomy in the treatment of SA, however, these findings were not statistically significant. Because of the heterogeneity of the data, further prospective studies are needed to draw definitive conclusions.
脾脓肿（SA）是一种罕见的、危及生命的疾病，通常采用脾切除术治疗。然而，这种方法与较高的死亡率和发病率相关。最近，经皮引流（PD）已成为某些患者的替代治疗方法。在本研究中，我们比较了采用脾切除术与 PD 治疗 SA 的患者的死亡率和并发症。
从 2019 年至 2020 年，我们对 13 个数据库和在线搜索引擎进行了系统的文献检索。使用双变量广义线性混合模型（BGLMM）对死亡率和并发症分别进行了单独的荟萃分析。我们使用非随机干预研究的偏倚风险（ROBINS-I）工具来评估非随机研究的偏倚风险，并使用推荐评估、制定与评价（GRADE）方法来评估证据质量和推荐强度。结果根据系统评价和荟萃分析的首选报告项目（PRISMA）指南呈现。
该综述纳入了来自 21 个国家的 46 项回顾性研究。对于死亡率，有 27 项研究比较了脾切除术和 PD，10 项研究仅采用 PD，9 项研究仅采用脾切除术。在 18 项两臂研究、7 项单臂 PD 研究和 7 项单臂脾切除术研究中，有主要并发症的数据。在总共 589 名患者中，288 名接受了脾切除术，301 名接受了 PD。脾切除术组的死亡率为 12%（95%可信区间 [CI]，8%-17%），PD 组为 8%（95% CI，4%-13%）。脾切除术组的并发症发生率为 26%（95% CI，16%-37%），PD 组为 10%（95% CI，4%-17%）。
与脾切除术相比，经皮引流与 SA 治疗中的并发症和死亡率降低趋势相关，但这些发现无统计学意义。由于数据的异质性，需要进一步的前瞻性研究来得出明确的结论。
