Mahmoud Abdelrahman, Abuelazm Mohamed, Ahmed Ali Ashraf Salah, Elshinawy Mahmoud, Abdelwahab Omar Ahmed, Abdalshafy Hassan, Abdelazeem Basel
Faculty of Medicine, Minia University, Minia, Egypt.
Faculty of Medicine, Tanta University, Tanta, Egypt.
Ann Transl Med. 2023 Mar 15;11(5):190. doi: 10.21037/atm-22-4663. Epub 2023 Mar 8.
Liver abscess is a life-threatening condition. Percutaneous catheter drainage (PCD) and percutaneous needle aspiration (PNA) are both minimally invasive techniques used to manage liver abscess. We aim to compare both techniques' efficacy and safety.
We performed a systematic review and meta-analysis involving randomized controlled trials (RCTs) from PubMed, Embase, Scopus, WOS, Cochrane, and Google scholar until July 22, 2022. We pooled dichotomous outcomes using risk ratio (RR) presented with a 95% confidence interval (CI) and continuous outcomes using mean difference (MD) with 95% CI. We registered our protocol with ID: CRD42022348755.
We included 15 RCTs with 1,626 patients. Pooled RR favored PCD (RR: 1.21 with 95% CI: 1.11, 1.31, P<0.00001) in success rate and recurrence after six months (RR: 0.41 with 95% CI: 0.22, 0.79, P=0.007). We found no difference in adverse events (RR: 2.2 with 95% CI: 0.51, 9.54, P=0.29). Pooled MD favored PCD in time to clinical improvement (MD: -1.78 with 95% CI: -2.50, -1.06, P<0.00001), time to achieve 50% reduction (MD: -2.83 with 95% CI: -3.36, -2.30], P<0.00001) and duration of antibiotic needed (MD: -2.13 with 95% CI: -3.84, -0.42, P=0.01). We found no difference in the duration of hospitalization (MD: -0.72 with 95% CI: -1.48, 0.03, P=0.06). The results were heterogeneous for all the continuous outcomes which were all measured in days.
Our updated meta-analysis concluded that PCD is more effective than PNA in liver abscess drainage. However, evidence is still uncertain, and more high-quality trials are still required to confirm our results.
肝脓肿是一种危及生命的疾病。经皮导管引流（PCD）和经皮穿刺抽吸（PNA）都是用于治疗肝脓肿的微创技术。我们旨在比较这两种技术的疗效和安全性。
我们进行了一项系统评价和荟萃分析，纳入了截至2022年7月22日来自PubMed、Embase、Scopus、WOS、Cochrane和谷歌学术的随机对照试验（RCT）。我们使用风险比（RR）合并二分结果，并给出95%置信区间（CI），使用平均差（MD）合并连续结果，并给出95%CI。我们将方案注册为ID：CRD42022348755。
我们纳入了15项RCT，共1626例患者。在成功率和六个月后的复发率方面，合并RR支持PCD（RR：1.21，95%CI：1.11，1.31，P<0.00001）。我们发现不良事件方面没有差异（RR：2.2，95%CI：0.51，9.54，P=I0.29）。在临床改善时间、实现50%缩小的时间以及所需抗生素持续时间方面，合并MD支持PCD（MD：-1.78，95%CI：-2.50，-1.06，P<0.00001；MD：-2.83，95%CI：-3.36，-2.30，P<0.00001；MD：-2.13，95%CI：-3.84，-0.42，P=0.01）。我们发现住院时间没有差异（MD：-0.72，95%CI：-1.48，0.03，P=0.06）。所有以天为单位测量的连续结果的结果均存在异质性。
我们更新的荟萃分析得出结论，在肝脓肿引流方面，PCD比PNA更有效。然而，证据仍然不确定，仍需要更多高质量的试验来证实我们的结果。
