中国实用外科杂志

中国实用外科杂志

• 外科临床焦点 • 上一篇    下一篇

直肠手术后难治性盆腔脓肿6例诊治体会

杨    勇1，王振军1，赵宝成1，高志刚1，翟志伟1，刘佐军2，魏广辉1，李晓滨2   

  1. 1首都医科大学附属北京朝阳医院普外科，北京 100020；2首都医科大学附属北京潞河医院普外科，北京 101100
  • 出版日期:2016-10-01 发布日期:2016-09-28

  • Online:2016-10-01 Published:2016-09-28

摘要：

目的    探讨一种特殊的直肠手术后难治性盆腔脓肿的临床特点及治疗方法。方法    回顾性分析2011年10月至2016年2月首都医科大学附属北京朝阳医院普外科（5例）和北京潞河医院普外科（1例）收治的共6例直肠手术后难治性盆腔脓肿病人的临床资料。结果    4例病人行肠造口手术，并经多次手术清除感染组织后治愈；1例经治疗后行造口还纳，盆腔感染复发，再次行造口及清创手术，未愈；1例暂时经直肠吻合口漏行盆腔感染清创换药，未愈。结论    此类直肠手术后难治性盆腔脓肿较既往常见类型存在病史时间长、合并症多、治疗方法复杂、迁延不易愈合、预后较差等特点。因此，直肠手术中，在盆腔没有活动出血的情况下，尽量避免不必要的预防性止血纱布填塞或其他止血材料置入，可能为预防这种难治性盆腔脓肿的关键所在。

关键词: 直肠手术, 异物感染, 盆腔脓肿

Abstract:

Diagnosis and treatment of refractory pelvic abscess after rectal surgery：An analysis of 6 cases        YANG Yong*, WANG Zhen-jun, ZHAO Bao-cheng, et al. *Department of General Surgery, Beijing Chao Yang Hospital, Capital Medical University, Beijing 100020, China
Corresponding author: WANG Zhen-jun, E-mail: drzhenjun@163.com
Abstract    Objective    To introduce a special kind of refractory pelvic abscess after rectal surgery and discuss its clinical characteristics and therapy. Methods    The clinical characteristics, follow-up data and prognosis of 6 cases of refractory pelvic abscess admitted from October 2011 to February 2016 in Department of General Surgery, Beijing Chao Yang Hospital, Capital Medical University（5 cases）and Department of General Surgery,Beijing Luhe Hospital（1 case）were analyzed retrospectively. Results    Four cases were cured by enterostomy and clearance of infection tissue in surgical operation. After the closing of intestinal stoma, 1 case of pelvic abscess relapsed and was performed reenterostomy and clearance but was unhealed. One case was under the treatment of debriding pelvic abscess through the rectal anastomotic leakage, but was unhealed. Conclusion    In comparison with common pelvic abscess, the refractory pelvic abscess has such features as a long medical history, more complications, complex therapies, delayed healing and poor prognosis. During the rectal surgery, if no active bleeding happened, the hemostatic gauze or material should not be placed in the pelvic. And it’s the key point to prevent the kind of refractory pelvic abscess.

Key words: rectal surgery, foreign material infection, pelvic abscess