仙骨前空間への針の進入による直腸穿刺のリスク。直腸と仙骨の距離、仙骨の厚みを測定することの重要性

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.

• Young Suk Kwon
• Narea Lee
• Ho Seok Lee
• Eun Ji Youn
• Soo Kyung Lee
• Youngmi Kim
• Jae Jun Lee

抄録

ガングリオンインパーブロックの際には、尾部麻酔の際に針が仙骨前空間に近づき、仙骨が貫通する可能性があります。直腸は仙骨の前にあり、したがって、穿刺のためのリスクがあるので、それは仙骨と直腸の間の距離を決定することが重要であるだけでなく、仙骨の厚さを測定するために使用されました。仙骨と直腸の距離、仙骨関節と直腸の距離、仙骨レベル5（「仙骨5」）と直腸の距離、仙骨4～5接合部と直腸の距離を測定した。直腸内の便の有無で比較した。仙骨の厚さは、仙骨4～5接合部と仙骨接合部で測定した。仙骨と直腸の間の距離を除いて、すべての距離は男女ともに1"Zs_200A"mm以下であった。男女ともに、直腸内の便の有無による仙骨と直腸の距離に有意差はなかったが、男性では第5仙骨と直腸の距離に差があった（P"Zs_200A"="Zs_200A".048）。仙骨関節部の厚みが5"Zs_200A"mm以下の患者さんが男女数名、仙骨と直腸の距離が1"Zs_200A"mm以下の患者さんもいました。仙骨前空間に針を適用するときに医師は注意を行使する必要があります。尾部ブロック中に誤って仙骨が貫通した場合、直腸穿刺を否定することはできない。排泄物の排泄は、メスの場合、仙骨と直腸の間の距離に影響を与えない。

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.