Department of Obstetrics and Gynecology, Faculty of Medicine, Necmettin Erbakan University, Konya, Türkiye.
Arch Gynecol Obstet. 2023 Oct;308(4):1321-1326. doi: 10.1007/s00404-023-07117-2. Epub 2023 Jun 30.
We aimed to compare the results of image-guided drainage in addition to antibiotic therapy (antibiotherapy) with antibiotherapy alone in the treatment of tubo-ovarian abscesses (TOAs) and evaluate C-reactive protein (CRP) levels in predicting the success of antibiotherapy.
This was a retrospective study of 194 patients hospitalized with TOA. Patients were divided into the following two groups: those who underwent image-guided drainage in addition to parenteral antibiotherapy and those who did not undergo image-guided drainage and received antibiotherapy alone. CRP levels on the day of admission (day 0), day 4 of hospitalization (day 4), and day of discharge (last day) were recorded. The percentage of decrease in CRP levels during day 4 and the last day compared with that on day 0 was calculated.
A total of 106 patients (54.6%) underwent image-guided drainage with antibiotherapy, whereas 88 patients (45.4%) did not undergo drainage and received antibiotherapy alone. At admission, the mean CRP level was 203.4 (± 96.7) mg/L and was similar in both groups. The mean decrease in the CRP level on day 4 compared with that on day 0 was 48.5% and was statistically higher in the group that underwent image-guided drainage. Antibiotherapy failed in 18 patients, and a statistically significant difference was observed between treatment failure and the rate of decrease in the CRP level on day 4 compared with that on day 0. According to the receiver operating characteristic (ROC) analysis, if the CRP level measured on day 4 decreased by < 37.1% compared with that on day 0, the probability of treatment failure would increase (area under the curve = 0.755; 95% confidence interval, 0.668-0.841; sensitivity, 73.6%; specificity, 60%).
Image-guided drainage combined with antibiotherapy in the treatment of TOA has high success rates, lower recurrence rates, and lower surgical requirement, and the mean decrease in the CRP level on day 4 can be monitored at treatment follow-up. In patients receiving antibiotherapy alone, if the CRP level on day 4 decreases by < 37.1%, the treatment protocol should be changed.
比较在抗生素治疗（抗菌治疗）的基础上联合影像引导下引流与单纯抗菌治疗对输卵管卵巢脓肿（TOA）的疗效，并评估 C 反应蛋白（CRP）水平对预测抗菌治疗效果的价值。
这是一项回顾性研究，共纳入 194 例因 TOA 住院的患者。患者被分为以下两组：一组接受影像引导下引流+静脉抗菌治疗，另一组仅接受抗菌治疗。记录患者入院当天（第 0 天）、住院第 4 天（第 4 天）和出院当天（最后一天）的 CRP 水平。计算第 4 天和最后一天与第 0 天相比 CRP 水平下降的百分比。
共 106 例（54.6%）患者接受了影像引导下引流+抗菌治疗，88 例（45.4%）患者未接受引流而仅接受了抗菌治疗。入院时，两组患者的 CRP 水平均为 203.4（±96.7）mg/L，差异无统计学意义。与第 0 天相比，第 4 天的 CRP 水平平均下降 48.5%，且引流组的下降幅度更大，差异有统计学意义。18 例患者抗菌治疗失败，且第 4 天 CRP 水平下降幅度与治疗失败率之间存在显著差异。根据受试者工作特征（ROC）分析，如果与第 0 天相比，第 4 天的 CRP 水平下降幅度<37.1%，则治疗失败的可能性增加（曲线下面积为 0.755；95%置信区间为 0.668-0.841；敏感性为 73.6%，特异性为 60%）。
影像引导下引流联合抗菌治疗治疗 TOA 的成功率高、复发率低、手术需求低，且在治疗随访时可监测第 4 天 CRP 水平的下降幅度。对于单纯接受抗菌治疗的患者，如果第 4 天的 CRP 水平下降幅度<37.1%，则应改变治疗方案。
