Department of Gynecology and Gynecological Oncology, Inselspital, Bern University Hospital, University of Bern, Friedbuehlstrasse 19, 3010, Bern, Switzerland.
Arch Gynecol Obstet. 2023 Jan;307(1):139-148. doi: 10.1007/s00404-022-06743-6. Epub 2022 Aug 29.
To evaluate the clinical outcomes and prognosis of patients undergoing laparoscopic surgery for tubo-ovarian abscess (TOA) and identify risk factors for pelvic inflammatory disease (PID) recurrence.
We conducted a retrospective cohort analysis including 98 women who underwent laparoscopic surgery for TOA at the Department of Obstetrics and Gynecology at the Bern University Hospital from January 2011 to May 2021. The primary outcome studied was the recurrence of PID after TOA surgery. Clinical, laboratory, imaging, and surgical outcomes were examined as possible risk factors for PID recurrence.
Out of the 98 patients included in the study, 21 (21.4%) presented at least one PID recurrence after surgery. In the univariate regression analysis, the presence of endometriosis, ovarian endometrioma, and the isolation of E. coli in the microbiology cultures correlated with PID recurrence. However, only endometriosis was identified as an independent risk factor in the multivariate analysis (OR (95% CI): 9.62 (1.931, 47.924), p < 0.01). With regard to the time of recurrence after surgery, two distinct recurrence clusters were observed. All patients with early recurrence (≤ 45 days after TOA surgery) were cured after 1 or 2 additional interventions, whereas 40% of the patients with late recurrence (> 45 days after TOA surgery) required 3 or more additional interventions until cured.
Endometriosis is a significant risk factor for PID recurrence after TOA surgery. Optimized therapeutic strategies such as closer postsurgical follow-up as well as longer antibiotic and hormonal therapy should be assessed in further studies in this specific patient population.
评估接受腹腔镜手术治疗输卵管卵巢脓肿（TOA）的患者的临床结局和预后，并确定盆腔炎（PID）复发的危险因素。
我们进行了一项回顾性队列分析，纳入了 2011 年 1 月至 2021 年 5 月在伯尔尼大学医院妇产科接受腹腔镜手术治疗 TOA 的 98 名女性患者。研究的主要结局是 TOA 手术后 PID 的复发。检查了临床、实验室、影像学和手术结果，作为 PID 复发的可能危险因素。
在纳入研究的 98 名患者中，有 21 名（21.4%）在手术后至少出现一次 PID 复发。在单变量回归分析中，存在子宫内膜异位症、卵巢子宫内膜异位囊肿和微生物培养中分离出大肠杆菌与 PID 复发相关。然而，只有子宫内膜异位症在多变量分析中被确定为独立危险因素（OR（95%CI）：9.62（1.931，47.924），p<0.01）。就手术后复发的时间而言，观察到两个明显的复发簇。所有早期复发（TOA 手术后≤45 天）的患者在 1 或 2 次额外干预后均得到治愈，而 40%的晚期复发（TOA 手术后>45 天）的患者需要 3 次或更多次额外干预才能治愈。
子宫内膜异位症是 TOA 手术后 PID 复发的一个显著危险因素。在这一特定患者群体中，应进一步研究评估优化的治疗策略，如更密切的术后随访以及更长时间的抗生素和激素治疗。
