| Objective: To compare the treatment methods of tubo-ovarian abscess,and to analyze the best treatment method.Methods: The clinical data of the first onset of tubal ovarian abscess diagnosed by Shengjing Hospital from January 1,2011 to December 31,2016 in China Medical University were analyzed retrospectively.A total of 590 cases(406 cases,including telephone follow-up)non surgical treatment of 37 cases(25 cases of telephone follow-up),553 cases of surgical treatment,surgical treatment is divided into 3 ways of treatment,including 382 cases of laparotomy(266 cases,telephone follow-up)in 102 cases of laparoscopic surgery(telephone follow-up 70 cases),puncture drainage in 69 cases(telephone follow-up 44 cases),clinical characteristics,diagnosis and treatment process of several groups of patients(indexes related to preoperative,intraoperative and postoperative)and prognosis.Results: 1.Compared to patients in general condition of the patients,the patients in each group(age 42.5±9.2、43.7±8.0),abscess size(10.0±2.9、10.3±2.5),abscess location,preoperative white blood cell count(11.6±7.3、11.5±5.1),CRP(137.2±69.7、128.3±87.8),intrauterine devices in use(48.6%,54.4%),(16.2%,12.5%)a history of appendicitis,there was no significant difference in reproductive history(P > 0.05).2.according to whether the surgery is divided into operation group and non operation group,operation group and non operation group were compared,two groups in hospitalization(13.7±6.4、10.1±3.5)time,antibiotics(10.7±5.6、9.3±3.4),the cost of treatment(25846±12561、10117±6208)on the non operative group were significantly lower than the surgery group,there was significant difference(P < 0.05),and the prognosis of recurrence,surgical treatment group,the recurrence rate is low(11.3%,40%).3.according to the different methods of surgery operation were divided into laparotomy group,laparoscopic group and puncture group,compared with three in the surgery,hospitalization(14.6±6.5、11.7±4.1、11.7±7.2),time of antibiotics(11.1±5.4、9.0±4.6、10.3±7.4),cost(28063±12863、26013±7552、13489±9716),bleeding(139.3±210.8、107.1±169.9、65.0 ± 92.5),postoperative exhaust time(60.3±22.2 、 44.8±18.0 、 57.1±22.2),operation time(107.0±53.2、108.0±48.1、44.4±40.2)and the prognosis of the patients(9.3%,4.2%,40.8%)there was a significant difference(P < 0.05).4.for laparotomy and laparoscopic surgery compared to radical surgery(USO/BSO)with respect to adhesion loose knot or only tubal resection,prognosis and recurrence rate is low,compared to the same type of surgery,laparoscopic surgery with laparotomy in patients with low recurrence rate.5.The prognosis of the operative group was studied.Multivariate analysis showed that the operative mode(HR = 0.15,0.10,0.39),age(HR = 0.96),and hospitalization days(HR 1.03)were independent prognostic factors for TOA recurrence(P < 0.05).Conclusion: The treatment of tubal ovarian abscess in the surgical treatment of non surgical treatment can obtain good curative effect and economic advantages,in the treatment of TOA should be the preferred option for surgical treatment;in the choice of surgical approach,laparoscopy and laparotomy and TOA puncture drainage compared to surgical options for radical surgery the best,for the choice of surgical approach,quick recovery,less complications and protection of reproductive function,low recurrence rate,cost-effective advantage of laparoscopic surgery after surgery,it is worthy of clinical application. |
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