CAJ | 학술논문

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20～90 min、导管留置时间0～45 d、引流液0～2500 ml；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≥8 F的留置导管、无吻合口瘘临床疗效好。
목적：탐토CT인도하경피천자인류직장암술후계발분강농종적가행성、료효화영향림상료효적인소，위림상치료제공삼고의거。방법선취2005년5월－2013년8월37례직장암술후발생분강농종，내과보수치료실패후접수CT인도하경피천자농종인류술，채용SPSS16．0연건진행통계분석。결과 CT인도하분강농종천자인류기술림상성공솔위100．00％；천자치관채용사로경4례점10．81％、전로경7례점18．92％화후로경26례점70．27％，천자치관시간20～90 min、도관류치시간0～45 d、인류액0～2500 ml；병원균배양양성31례，양성솔83．78％，대장애희균시주요치병균，공30주，점96．78％；림상실패공5례，균접수수술치료；림상료효여불동형호적도관（ P＜0．001）화시부존재문합구루（ P＝0．001）유관；경미병발증4례，발생솔10．81％。결론설계합리적천자로경，행CT인도하경피천자인류직장암술후계발분강농종안전、유효，채용≥8 F적류치도관、무문합구루림상료효호。
OBJECTIVE To assess the feasibility and efficacy of CT‐guided percutaneous catheter drainage in treat‐ment for postoperative pelvic abscesses in rectal cancer patients ,then analyze factors influencing clinical efficacy so as to provide reference for clinical treatment .METHODS Totally 37 rectal cancer patients were selected who had postoperative pelvis abscesses from May 2005 to Aug .2013 and received CT‐guided percutaneous drainage after failure of conservation treatment .The software SPSS16 .0 was used for statistical analysis .RESULTS As for tech‐nical outcomes ,all of the 37 cases (100% ) were successful .As for clinical outcomes ,86 .5% (32/37)were cured . Catheterization routes included oblique route (4 cases ,10 .81% ) ,anterior route (7 cases ,18 .92% ) and posterior route (26 cases ,70 .27% ) .The mean duration of percutaneous catheter and continue drainage was 20~90 min and 0~45 d respectively .Volume of drainage contents was 0~2 500 ml .Laboratory cultures were positive in 31 patients (83 .78% ) and Escherichia coli was the most frequently present microorganism (30 strains ,96 .78% ) . Slight complications were observed in 4 patients (10 .81% ) .Clinical failure occurred in 5 patients(13 .51% ) whom received surgical treatment .The therapeutic influencing factors were types of catheter (P<0 .001) and presence of anastomotic stoma fistula(P=0 .001) .CONCLUSION Rationally designed CT‐guided percutaneous drainage is a safe ,well tolerated and effective procedure for postoperative pelvic abscesses in rectal cancer patients .Major com‐plications are rare .The therapeutic effect is better in type ≥ 8F catheter with absence of anastomotic stoma fistu‐la .