骶前囊肿切除术后囊壁残留并会阴部顽固性窦道的再次手术及围手术期处理方法的探讨  

Reoperation and perioperative management of residual cyst wall with perineal intractable sinus after resection of presacral cyst tumors

作　　者：张国强 王刚成 李红乐 古想花[2] 刘瑞霞[2] 丰锐[2] 王有财 刘英俊 张志 王红丽 Zhang Guoqiang;Wang Gangcheng;Li Hongle;Gu Xianghua;Liu Ruixia;Feng Rui;Wang Youcai;Liu Yingjun;Zhang Zhi;Wang Hongli(Department of General Surgery,Affiliated Cancer Hospital of Zhengzhou University,Henan Provincial Cancer Hospital,Zhengzhou 450000,China;Henan Medical Information Research Institute,Zhengzhou 450016,China)

机构地区：[1]河南省肿瘤医院郑州大学附属肿瘤医院普外科,450000 [2]河南省医学情报研究所,郑州450016

出　　处：《中华肿瘤杂志》2021年第9期973-978,共6页Chinese Journal of Oncology

基　　金：河南省科技攻关重点项目(202102310109);河南省卫生健康委省部共建重点项目(SBGJ202002018、SB201901109)。

摘　　要：目的探讨骶前囊肿切除术后囊壁残留并会阴部顽固性窦道再次手术及围手术期处理方法。方法回顾性分析2014年1月至2019年8月郑州大学附属肿瘤医院收治的29例骶前囊肿切除术后囊壁残留并会阴部顽固性窦道患者的临床资料,分析骶前囊肿切除术后囊壁残留并会阴部顽固性窦道形成的特点、手术方式、围手术期的处理方法。结果29例骶前囊肿切除术后囊壁残留并会阴部顽固性窦道患者,表皮样囊肿9例,皮样囊肿7例,成熟畸胎瘤10例,囊肿癌变(包括尾肠囊肿癌变及畸胎瘤癌变)3例。29例患者外院手术入路均为后入路,其中1例联合经腹入路。全组患者接受再次骶前残留囊壁、窦道切除,其中25例为经会阴弧形切口入路,4例为经会阴弧形切口入路联合经腹入路。全组患者术后未出现严重并发症,术后病理及MRI显示残留囊壁均完整切除,窦道愈合。结论合理的手术入路及围手术期处理对骶前囊肿术后囊壁残留并会阴部顽固性窦道患者的残留囊壁完整切除及会阴部窦道愈合尤为重要。Objective To investigate the reoperation and perioperative management of residual cyst wall with perineal intractable sinus after resection of presacral cyst tumors.Methods The clinical data of 29 patients with residual cyst wall and perineal intractable sinus after resection of presacral cyst tumors in Affiliated Cancer Hospital of Zhengzhou University from January 2014 to August 2019 were reviewed,including the characteristics of the residual cyst wall with perineal intractable sinus after resection of presacral cyst tumors,surgical method,and perioperative management.Results Twenty-nine patients with residual cyst wall and perineal intractable sinus after resection of presacral cyst tumors,including 9 cases of epidermoid cysts,7 cases of dermoid cysts,10 cases of mature teratomas and 3 cases of malignant cysts(including malignant transformation of caudate cyst and teratoma);The 29 patients underwent posterior approaches for cyst resection in other hospital before,of whom 1 patient underwent posterior combined with transabdominal approach.All of thes patients underwent resection of residual presacral cyst wall and perineal intractable sinus in our hospital,of whom 25 patients underwent a transperineal approach through an arc-shaped incision anterior to the apex of the coccyx,and the other 4 patients underwent transperineal arc-shaped incision combined with transabdominal approach.All of the patients were cured without serious complications occurring,postoperative pathological and the magnetic resonance imaging diagnosis showed that the residual cyst wall and perineal intractable sinus were all completely removed.Conclusion Appropriate surgical approache and perioperative treatment for the patients with residual cyst wall and perineal intractable sinus are very important to promote the resection of residual cyst wall and the healing of perineal intractable sinus.

关 键 词：骶前囊肿 囊壁残留 会阴部顽固性窦道 经会阴弧形切口入路 

分 类 号：R657.1[医药卫生—外科学]