摘要
目的提高临床医师对直肠癌患者术后盆腔感染临床特点、发病原因以及诊疗方面的认识,为临床上此类疾病的诊断和治疗提供参考依据。方法回顾性分析江苏省中医院2020年12月至2023年6月收治的4例晚期直肠癌术后盆腔感染行骶尾部置管引流治疗患者的临床资料,总结晚期直肠癌术后盆腔感染的治疗经验。结果共纳入4例患者,男性3例,女性1例;中位年龄64.0(47.8,69.8)岁;其中有3例患者既往行小肠造口术,1例患者既往行结肠—直肠吻合术,该患者入院时影像学检查提示吻合口漏,予营养支持治疗,后续无异常。4例患者盆腔感染确诊中位间隔时间为18.0(11.5,28.3)d。骶尾部置管引流治疗前抗生素使用中位时间为3.5(1.3,6.5)d。骶尾部置管引流治疗外接引流管放置中位时间为4.0(3.3,4.8)d。4例患者引流液微生物培养结果提示引流液中主要为革兰阴性菌。引流后感染指标较术前下降。术后随访1个月,4例患者血生化检验炎性指标均未见异常,症状恢复良好,未见复发。除既往行结肠—直肠吻合术患者外,其余3例患者于术后3个月入我院复查无异常,成功行造口还纳手术,术后恢复良好。结论对于晚期直肠癌术后盆腔感染的患者应尽早引流,行骶尾部置管引流治疗疗效确切,预后良好。
Objectives To improve the understanding of the clinical characteristics,pathogenesis,diagnosis and treatment of postoperative pelvic infection in patients with rectal cancer,and to provide references for the diagnosis and treatment of such diseases.Methods The clinical data of patients with postoperative pelvic infection of advanced rectal cancer treated with sacrococcygeal catheter drainage from December 2020 to June 2023 in Jiangsu Provincial Hospital of Traditional Chinese Medicine were retrospectively analyzed,and the treatment experience of postoperative pelvic infection of advanced rectal cancer was summarized.Results A total of four patients were enrolled,including three males and one female,with an average age of 64.0(47.8,69.8)years.Among them,three patients had a history of enterostomy,whereas one patient had a history of colorectostomy.The patient had anastomotic fistula on imaging at admission,and received nutritional support treatment without subsequent abnormalities.The median interval to diagnosis of pelvic infection in these four patients was 18.0(11.5,28.3)d,and the median time to antibiotic use before catheter drainage was 3.5(1.3,6.5)d.The sacrococcygeal catheter drainage treatment process was smooth,the average time of external drainage tube was 4.0(3.3,4.8)d.After drainage,the infection indexes decreased compared with those before surgery,and after one month of follow-up,there was no abnormality in the inflammatory indexes of blood biochemical tests in the four patients,and the symptoms recovered well,and no recurrence was observed.Except for the patient who previously underwent colorectostomy,the other three patients were admitted to our hospital for review in three months after surgery,and successfully underwent small intestinal stoma closure operation.And the postoperative recovery was good.Conclusion For patients with pelvic infection after surgery for advanced rectal cancer,drainage should be done as soon as possible,and sacrococcygeal catheter drainage therapy has a definite effect and a good prognosis.
作者
李易鲜
许露露
陈鹏
江志伟
刘江
邵明月
柳欣欣
Li Yixian;Xu Lulu;Chen Peng;Jiang Zhiwei;Liu Jiang;Shao Mingyue;Liu Xinxin(First School of Medicine,Nanjing University of Chinese Medicine,Nanjing 210029,Jiangsu,China;Department of General Surgery,Jiangsu Provincial Hospital of Chinese Medicine(Affiliated Hospital of Nanjing University of Chinese Medicine),Nanjing 210029,Jiangsu,China)
出处
《结直肠肛门外科》
2024年第1期82-86,共5页
Journal of Colorectal & Anal Surgery
基金
江苏省重点学科项目(js2251)
江苏省中医药管理局重点项目(ZD201903)
江苏省中医院科研项目(Y22016)。
关键词
直肠癌
盆腔感染
骶尾部置管引流
rectal cancer
pelvic infection
sacrococcygeal catheter drainage
