评价超声引导下后入路骶前脓肿置管引流的临床应用价值。

选取2013年6月至2015年12月在中山大学附属第六医院就诊的，经本院CT或磁共振成像（MRI）检查诊为骶前脓肿，并行超声引导下经臀大肌置管引流的48例患者。分析骶前脓肿形成的病因、位置、大小、形态、导管型号、引流时间，与导管相关疼痛和置管操作相关并发症的发生率，以及短期与长期疗效，引流管使用的型号分别为8F、10F、12F及16F，并且根据导管型号将病例分为4组，比较组间脓肿引流时间的差异，采用Kruskal-Wallis检验，脓肿体积与引流时间相关性采用Pearson检验。

骶前脓肿成因包括直肠癌术后吻合口瘘38例，先天性巨结肠术后3例，放射性直肠炎2例，直肠癌术后复发并肠穿孔1例，克罗恩病1例，阑尾炎并脓肿形成1例，直肠瘘1例，胰腺假性囊肿术后1例。脓肿最大直径为24~135 mm，体积为4.8~283.4 ml。引流管使用型号为8-16F，引流管留置时间为1~52 d（平均13 d）。42例（91.3%，42/46）患者骶前脓肿可充分引流无需进一步手术，有4例（8.7%，4/46）患者引流效果不佳需进一步手术治疗。8-16F不同型号引流管组间引流时间比较，差异均无统计学意义（P均>0.05）。脓肿体积与引流时间呈正相关（r=0.281，P<0.05）。经臀大肌置管引流术中及术后均无明显并发症。

超声引导下经臀大肌引流是一种安全、有效和易耐受的深部盆腔脓肿治疗方法，值得临床推广应用。

To assess the value of percutaneous posterior ultrasound-guided transgluteal approach for draining presacral abscesses.

From June 2013 to December 2015, retrospectively reviewed were performed in 48 patients with presacral abscesses confirmed by CT or magnetic resonance imaging (MRI) were retrospectively reviewed, and these patients underwent percutaneous US-guided transgluteal abscess drainage and catheter placement. The medical records were reviewed to determine the origins, location, and size of the abscesses, size of catheter, duration of catheter drainage, incidence of catheter-related pain and procedure-related complications, and short and long-term outcomes. The duration of drainage among different size of drainage catheter was compared, and the correlation between the volume of abcess and duration of abcess drainage was analyzed.

The origins of the pelvic abscesses included anastomotic leakage after colorectal cancer surgery (n=38) and congenital macrocolon operation (n=3), radiation proctitis (n=2), recurrence of rectal cancer complicated with intestinal perforation, Crohn disease (n=1), appendicitis with abscess formation (n=1), rectal fistula (n=1), and postoperative pancreatic pseudocyst (n=1). The abscesses were 24-135 mm in diameter. The volume of the abscesses was 4.8-283.4 ml. The sizes of catheters used were 8-12F, and the mean duration of drainage was 13 days (range:1-52). In 42 (91.3%) of 46 patients, there was complete resolution of the abscess following transgluteal drainage, without subsequent surgery. In four of 46 (8.7%) patients, incomplete resolution necessitated subsequent surgery. No significant difference in drainage time was observed among 8-16F catheters (all P>0.05). The volume of abscess was positively correlated with the drainage time (r=0.281, P<0.05). No major complications were observed, either during or after the transgluteal procedure.

Percutaneous US-guided transgluteal drainage is a safe, effective and well tolerated alternative to surgery for deep pelvic abscesses, and thus is worthy of clinical application.