骶前囊肿规范化诊疗中国专家共识

Chinese expert consensus on standardized treatment of presacral cysts

骶前囊肿是位于骶尾骨与直肠之间的囊性或囊实性肿块,与骶尾骨筋膜、直肠及肛门括约肌等盆底组织关系密切,多数为良性疾病,目前,学者认为其起源与胚胎发育异常有关。骶前囊肿临床少见,具体发病率未见系统文献报道。骶前囊肿的治疗以手术切除为主,如果囊壁未彻底切除,则可能导致复发或骶尾部形成难以愈合的窦道,给患者造成极大的痛苦。然而,目前临床对骶前囊肿的认识不足,甚至将其与卵巢囊肿、肛周脓肿等疾病相混淆,同时对该疾病的治疗缺乏彻底切除囊壁的理念与手术技巧,常导致切除困难的骶前囊肿被姑息处理,不当的手术方式甚至可能损伤肛门括约肌或重要血管、神经等,造成肛门失禁、大出血等严重的并发症。共识总结了与骶前囊肿相关的多学科专家的意见及建议,旨在增进广大医师对骶前囊肿的认识,树立骶前囊肿治疗的正确理念,规范骶前囊肿手术方式及提高手术切除技巧。

Presacral cysts are cystic or cyst-solid lesions between the sacrum and rectum.They are closely connected with adjacent pelvic floor structures such as sacrococcygeal fascia,rectum and anal sphincter.They are usually benign and are believed to be caused by aberrant embryogenesis.Clinically they are rare and its true incidence rate is unknown.Surgical resection remains the major treatment of presacral cysts.Unless the cysts are completely resected,the recurrence are unavoidable.The recurrent cysts even generate hard-to-heal sinus in the sacrococcyx,and cause the patients extreme pain.However,the current knowledge of presacral cysts is vague,even confused with other diseases such as ovarian cysts and perianal abscesses.Moreover,lack of the correct surgical concept or skills leads to palliative treatment of complex presacral cysts and serious complications such as fecal incontinence and massive haemorrhage which were attributed to impairing the function of anal sphincter or important blood vessels and nerves.The consensus summarizes the opinions and experiences of multidisciplinary experts in presacral cysts,and aims to provide clinicians with more detailed concept of the treatment,standardize the surgical approach and improve the resected efficacy of presacral cysts.