Harisinghani Mukesh G, Gervais Debra A, Hahn Peter F, Cho Chie Hee, Jhaveri Kartik, Varghese Jose, Mueller Peter R
Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA.
Radiographics. 2002 Nov-Dec;22(6):1353-67. doi: 10.1148/rg.226025039.
Deep pelvic abscesses may present a unique challenge for percutaneous drainage because of numerous overlying structures, which preclude safe percutaneous access. These structures include the pelvic bones, intestine, bladder, iliac vessels, and gynecologic organs. Use of the transgluteal approach to drain these abscesses can circumvent these obstacles and provide a useful surgical alternative or a temporizing measure. The transgluteal approach requires a thorough understanding of the anatomy of the sciatic foramen region and associated anatomic structures. The ideal approach for transgluteal access is to insert the catheter as close to the sacrum as possible, at the level of the sacrospinous ligament. Transgluteal drainage can be performed with the tandem-trocar technique or the Seldinger technique. Modifications of the procedure are needle aspiration not followed by catheter placement, use of the angled gantry technique, bilateral transgluteal drainage, combined anterior and posterior drainage, and drainage of necrotic pelvic masses. The transgluteal approach is a useful option in pediatric patients. Daily catheter care is essential for successful percutaneous catheter therapy. Although pain has been cited as a common complication of the technique, this complication can be minimized with judicious use of analgesia and a meticulous technique. Other complications are hemorrhage and catheter malposition.
由于存在众多覆盖结构，经皮穿刺引流深部盆腔脓肿可能面临独特挑战，这些覆盖结构会妨碍安全的经皮穿刺入路。这些结构包括骨盆骨、肠道、膀胱、髂血管和妇科器官。采用经臀入路引流这些脓肿可规避这些障碍，并提供一种有效的手术替代方法或临时措施。经臀入路需要对坐骨大孔区域及相关解剖结构的解剖有透彻了解。经臀入路的理想方法是在骶棘韧带水平尽可能靠近骶骨处插入导管。经臀引流可采用双套管技术或Seldinger技术。该操作的改良方法包括单纯针吸不放置导管、使用斜位机架技术、双侧经臀引流、前后联合引流以及坏死性盆腔肿块引流。经臀入路在儿科患者中是一种有用的选择。每日导管护理对于经皮导管治疗的成功至关重要。尽管疼痛被认为是该技术的常见并发症，但通过合理使用镇痛剂和精细操作可将此并发症降至最低。其他并发症包括出血和导管位置不当。
