Drainage Of Tubo-ovarian Abscess Research Articles

Тубоовариальные абсцессы в репродуктивном периоде. Методологическое обоснование органосберегающего лечения

The issues of complex treatment of patients with tubo-ovarian abscesses (TOA) in the reproductive period were considered, the main component of which is ultrasound minimally invasive surgery – drainage of purulent inflammatory tubo-ovarian mass using transvaginal ultrasound. The technique, indications and contraindications for such treatment were presented. The immune homeostasis of patients with TOA was also studied, and it was shown that they had the expansive nature of proinflammatory changes in cytokine production, as well as activation of the Th1-type lymphocytes with a simultaneous decrease in the Th2-type lymphocytes activity. Therefore, it is appropriate to include immunostimulating agents in the complex of therapeutic measures, particularly inosine pranobex. Conclusion. Drainage of TOA under the control of transvaginal ultrasound can be considered as the choice of treatment of patients of reproductive age. Sixty days after the complex treatment, the proinflammatory nature of cytokine production in these patients changed to mild proinflammatory. Key words: tubo-ovarian abscesses, ultrasound mini-surgery, drainage, inosine pranobex

Retrospective study on the efficacy and prognostic factors of conservative versus drainage of tubo-ovarian abscesses.

Management of tubo-ovarian abscesses (TOA) is often complex and may include antibiotics, image-guided drainage via interventional radiology (IR) or surgery. We aim to (i) identify clinical factors that prognosticate primary drainage and (ii) compare outcomes of each treatment regimen. This is a retrospective analysis on patients with TOA, admitted to KK Hospital, a tertiary women's hospital in Singapore from June 2016 to June 2017. Pregnant patients or patients who were discharged against medical advice were excluded. 102 patients were included in this study. 85.3% patients received antibiotics only, while 14.7% patients received antibiotics with IR drainage or surgery (primary drainage) as initial treatment. Subsequently, 20.7% failed antibiotic treatment and required IR drainage or surgery (secondary drainage). Patients aged above 40years, TOA diameter of larger than 7cm and presence of fever were found to be predictive of antibiotic failure, requiring secondary drainage. However, patients with primary drainage had a longer length of stay by 2.69 days (95% CI 1.44-3.94, p value < 0.001), compared to patients successfully managed conservatively. Patients who are above 40years, febrile and have a larger TOA are at a higher risk of medical treatment failure, and should, therefore, be recommended for primary drainage at presentation. Further prospective studies should be conducted with a larger sample size to compare the outcomes of conservative management versus drainage of TOA.