经臀部穿刺置双套管治疗深部盆腔脓肿效果分析  

Analysis of the effect of transgluteal percutaneous drainage in the treatment of deep pelvic abscess

作　　者：任华建 张锦鹏 田芮暇 王革非 顾国胜 洪之武 吴磊 郑涛 张洪贞 任建安 Ren Huajian;Zhang Jinpeng;Tian Ruixia;Wang Gefei;Gu Guosheng;Hong Zhiwu;Wu Lei;Zheng Tao;Zhang Hongzhen;Ren Jian'an(Department of General Surgery,Jinling Hospital,Nanjing,Jiangsu 210002,China;Department of General Surgery,Nanjing BenQ Hospital,Nanjing,Jiangsu 210000,China;Department of General Surgery,Huazhong University of Science and Technology Union Shenzhen Hospital,Shenzhen,Guangdong 518000,China)

机构地区：[1]东部战区总医院普通外科,南京210002 [2]南京明基医院普通外科,210000 [3]华中科技大学协和深圳医院普通外科,518000

出　　处：《中华胃肠外科杂志》2020年第12期1177-1181,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：江苏省卫生健康委科研课题面上项目(H2018058)。

摘　　要：目的探讨经臀部穿刺置双套管引流在处理深部盆腔脓肿中的安全性和可行性。方法采用描述性病例系列研究方法,回顾性分析2017年5月至2020年9月东部战区总医院普通外科收治的经臀部穿刺置双套管引流深部盆腔脓肿患者的临床资料。共纳入7例患者,男性5例,女性2例,中位年龄53.0(26~74)岁,均合并消化道瘘。其中1例男性患者因管道脱落再次穿刺置入双套管,因此7例患者一共经历8次经臀部穿刺引流术,均经CT引导下进行。经臀部穿刺放置双套管引流步骤如下:(1)CT下侧卧位定位穿刺点;(2)将腹腔镜手术的Trocar穿刺器置入脓腔内;(3)CT证实Trocar位于脓腔内;(4)拔出内芯,经操作孔置入双套管;(5)CT证实双套管位于脓腔内;(6)妥善固定双套管,防止脱落。收集所有患者穿刺前及穿刺后1、3和5 d的白细胞计数、C反应蛋白(CRP)、降钙素原和白介素⁃6(IL⁃6)等感染指标,以及穿刺液的细菌培养学结果。比较患者穿刺前后各感染指标的变化情况。结果总共7例患者均获得治愈,所有患者均未出现穿刺后大出血及严重疼痛;患者平均带管时间为60.8(18~126)d。5例患者最终因消化道瘘行消化道重建手术治疗。患者术前、术后1、3和5 d的中位血清IL⁃6水平分别为181.6(113.0,405.4)μg/L、122.2(55.8,226.0)μg/L、59.2(29.0,203.5)μg/L、64.1(30.0,88.4)μg/L,穿刺后3 d和5 d的血清IL⁃6水平较穿刺前下降,差异有统计学意义(F=3.586,P=0.026);白细胞计数、CRP和降钙素原水平穿刺后虽有下降,但是与穿刺前比较,差异没有统计学意义(均P>0.05)。结论经臀部穿刺置双套管引流操作简单,引流效果好,可以用于深部盆腔脓肿的治疗。Objective To investigate the safety and feasibility of transgluteal percutaneous drainage using double catheterization cannula in the treatment of deep pelvic abscess.Methods A retrospective analysis of the clinical data of patients who underwent transgluteal percutaneous drainage using double catheterization cannula with deep pelvic abscesses admitted to the Jinling Hospital from May 2017 to September 2020 was conducted.Seven patients were enrolled,including 5 males and 2 females,who aged 26⁃74(median 53.0)years old,and all of them had digestive fistula.One male patient was punctured again due to the tube falling off,and a total of 7 patients underwent 8 times of transgluteal percutaneous drainage,all under the guidance of CT.The puncture and drainage steps of the double catheterization cannula group are as follows:(1)Locate the puncture point under CT in the lateral position;(2)Place the trocar into the abscess cavity;(3)Confirm that the trocar is located in the abscess cavity under CT;(4)Pull out the inner core and insert into the double catheterization cannula through the operating hole;(5)Confirmthat the double catheterization cannula is located in the abscess cavity under CT;(6)The double catheterization cannula is properly fixed to prevent it from falling off.The white blood cells,C⁃reactive protein(CRP),procalcitonin,and interleukin⁃6(IL⁃6)of all patients before the drainage and 1 days,3 days,and 5 days after the drainage were collected,as well as the bacterial culture results of the drainage fluid.The changes of various infection biomarkers before and after the drainage were compared.Results All 7 patients were cured.No complications such as hemorrhage and severe pain were observed.The average time with drainage tube was 60.8(18⁃126)days.Five patients finally underwent gastrointestinal reconstruction surgery due to gastrointestinal fistula.The median serum interleukin⁃6 of patients before drainage,1 day,3 days and 5 days after drainage were 181.6(113.0,405.4)μg/L,122.2(55.8,226.0)μg/L,59.2(

关 键 词：盆腔脓肿 深部 经臀部脓肿穿刺引流 双套管 

分 类 号：R711.33[医药卫生—妇产科学]