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目的探讨CT引导下经皮穿刺引流直肠癌术后继发盆腔脓肿的可行性、疗效和影响临床疗效的因素,为临床治疗提供参考依据。方法选取2005年5月-2013年8月37例直肠癌术后发生盆腔脓肿,内科保守治疗失败后接受CT引导下经皮穿刺脓肿引流术,采用SPSS16.0软件进行统计分析。结果 CT引导下盆腔脓肿穿刺引流技术临床成功率为100.00%;穿刺置管采用斜路径4例占10.81%、前路径7例占18.92%和后路径26例占70.27%,穿刺置管时间20~90min、导管留置时间0~45d、引流液0~2 500ml;病原菌培养阳性31例,阳性率83.78%,大肠埃希菌是主要致病菌,共30株,占96.78%;临床失败共5例,均接受手术治疗;临床疗效与不同型号的导管(P<0.001)和是否存在吻合口瘘(P=0.001)有关;轻微并发症4例,发生率10.81%。结论设计合理的穿刺路径,行CT引导下经皮穿刺引流直肠癌术后继发盆腔脓肿安全、有效,采用≥8F的留置导管、无吻合口瘘临床疗效好。
Objective To investigate the feasibility, efficacy and factors influencing clinical curative effect of CT-guided percutaneous drainage of rectal cancer after pelvic abscess, so as to provide a reference for clinical treatment. Methods From May 2005 to August 2013, pelvic abscess was performed in 37 patients with rectal cancer. After conservative treatment failed, CT-guided percutaneous abscess drainage was performed. The data were analyzed by SPSS16.0 software. Results The clinical success rate of CT guided pelvic abscess drainage was 100.00%. Incision catheterization was performed in 4 cases (10.81%) of oblique path, 7 cases (18.92%) of anterior approach and 26 (70.27%) posterior approach, 90min, catheter indwelling time 0 ~ 45d, draining fluid 0 ~ 2 500ml; pathogen culture positive 31 cases, the positive rate of 83.78%, Escherichia coli is the main pathogens, a total of 30 strains, accounting for 96.78%; 5 cases of clinical failure , Were undergone surgical treatment; clinical efficacy and different types of catheters (P <0.001) and the presence of anastomotic fistula (P = 0.001); mild complications in 4 cases, the incidence rate of 10.81%. Conclusions The reasonable designed puncture route is safe and effective in percutaneous postoperative pelvic abscess drainage under the guidance of CT guided percutaneous drainage. The catheter with ≥8F indwelling catheter has good clinical curative effect without anastomotic fistula.