盆腔骶前间隙感染长期不愈的原因分析及处理技巧探讨

Analysis of the causes of long-standing pelvic anterior sacral space infection and discussion of management techniques

目的探讨盆腔骶前间隙感染长期不愈合的原因及处理方法。方法收集2015年10月至2020年10月郑州大学附属肿瘤医院收治的10例骶前顽固感染患者的临床资料。根据患者初次手术术式不同采用不同的手术方式治疗骶前感染。结果10例患者中,宫颈癌放疗后直肠漏出现骶前顽固感染2例,直肠癌Dixons术后放疗后出现直肠肠漏致骶前顽固感染3例,直肠癌Miles术后辅助放疗骶前出现顽固感染窦道5例。5例肠漏患者中,4例行破溃无功能肠管全部切除,同时采用骶前横弧形切口进行彻底骶前感染灶清创+带蒂大网膜填塞骶前间隙;1例肛管持续引流,骶前横弧形切口行彻底骶前感染灶清创。5例Miles术后患者全部采用骶前横弧形切口联合腹部切口行骶前感染灶清创。10例患者,9例患者骶前感染全部愈合,1例尚在治疗中。9例已治愈的骶前感染患者术后恢复时间为26~210 d,中位时间为55 d。结论肠漏患者骶前感染原因均为残余肠管分泌肠液进入骶前间隙,Miles术后患者为骶前残留异物导致感染。骶前尾骨前横弧形切口联合腹部切口是骶前顽固感染彻底清创的一种有效手术方式。

Objective To investigate the causes and management of long-term persistent pelvic presacral space infection.Methods Clinical data of 10 patients with persistent presacral infection admitted to the Cancer Hospital of Zhengzhou University from October 2015 to October 2020 were collected.Different surgical approaches were used to treat the presacral infection according to the patients′initial surgical procedures.Results Among the 10 patients,there were 2 cases of presacral recurrent infection due to rectal leak after radiotherapy for cervical cancer,3 cases of presacral recurrent infection due to rectal leak after radiotherapy for rectal cancer Dixons,and 5 cases of presacral recurrent infection of sinus tract after adjuvant radiotherapy for rectal cancer Miles.Of the 5 patients with leaky bowel,4 had complete resection of the ruptured nonfunctional bowel and complete debridement of the presacral infection using an anterior transverse sacral incision with a large tipped omentum filling the presacral space;1 had continuous drainage of the anal canal and complete debridement of the presacral infection using an anterior transverse sacral incision.5 post-Miles patients all had debridement of the presacral infection using an anterior transverse sacral incision combined with an abdominal incision.The nine patients with healed presacral infection recovered from surgery in 26 to 210 days,with a median time of 55 days.Conclusions Anterior sacral infections in patients with leaky gut are caused by residual bowel secretion of intestinal fluid into the anterior sacral space,and in post-Miles patients by residual anterior sacral foreign bodies.An anterior sacral caudal transverse arc incision combined with an abdominal incision is an effective surgical approach for complete debridement of anterior sacral recalcitrant infections.