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Risk of rectal puncture due to needle entry into the presacral space: Importance of measuring the distance between the rectum and sacrococcyx, and the thickness of the sacrococcyx.

由于针进入骶前间隙而导致直肠穿刺的风险: 测量直肠和骶尾骨之间的距离以及骶尾骨厚度的重要性。

  • 影响因子:1.95
  • DOI:10.1097/MD.0000000000020935
  • 作者列表:"Kwon YS","Lee N","Lee HS","Youn EJ","Lee SK","Kim Y","Lee JJ
  • 发表时间:2020-07-10
Abstract

:During ganglion impar block, the needle may approach the presacral space and the sacrum may be penetrated during caudal anesthesia. Because the rectum is in front of the sacrococcyx and is thus at risk for puncture, it is important to determine the distance between the sacrococcyx and rectum, as well as the thickness of the sacrococcyx.Computed tomography was used to measure the distance between the rectum and sacrococcyx, as well as the thickness of the sacrococcyx. The distances between the coccyx and rectum, sacrococcygeal joint and rectum, sacral level 5 ('sacrum 5') and rectum, and 'sacrum 4 to 5 junction' and rectum were measured. The results were compared based on the presence or absence of stools in the rectum. The thickness of the sacrococcyx was measured at the sacrum 4 to 5 junction and sacrococcygeal joint.In total, 1264 patients were included in this study. All distances were less than 1 mm in both males and females, with the exception of the distance between the coccyx and rectum in males. In both males and females, there was no significant difference in distance between the sacrococcyx and rectum according to the presence or absence of feces in the rectum, but there was a difference in the distance between sacrum 5 and the rectum in males (P = .048). Several male and female patients showed thicknesses of less than 5 mm at the sacrococcygeal joint.Some patients have a distance of less than 1 mm between the sacrum and rectum. Practitioners should exercise caution when applying a needle to the presacral space. If the sacrum is accidentally penetrated during caudal block, rectum puncture cannot be ruled out. Excretion of feces does not influence the distance between the sacrococcyx and rectum in females.

摘要

: 在神经节撞击阻滞期间,针可以接近骶前间隙,并且在尾部麻醉期间可以穿透骶骨。由于直肠位于骶尾骨的前面,因此有穿刺的危险,因此确定骶尾骨和直肠之间的距离以及骶尾骨的厚度是很重要的。计算机断层扫描用于测量直肠和骶尾骨之间的距离,以及骶尾骨的厚度。测量尾骨与直肠、骶尾部关节与直肠、骶骨水平5 (“骶骨5”) 与直肠、 “骶骨4 ~ 5交界处” 与直肠之间的距离。根据直肠中是否存在粪便来比较结果。在骶骨4 ~ 5交界处及骶尾部关节处测量骶尾骨厚度,共1264例患者纳入本研究。除男性尾骨和直肠之间的距离外,男性和女性的距离均小于1mm mm。在男性和女性中,根据直肠中有无粪便,骶尾骨与直肠的距离没有显著差异,但男性骶骨5与直肠的距离有差异 (p   =  .048)。一些男性和女性患者显示骶尾部关节的厚度小于5  mm。一些患者骶骨和直肠之间的距离小于1  mm。行医者在骶前间隙进针时应谨慎。如果骶尾部阻滞时不小心刺入骶骨,不能排除直肠穿刺。粪便的排泄不影响女性骶尾骨和直肠之间的距离。

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