骶前囊肿是一类位于直肠与骶骨之间的盆腔囊性病变，病理类型多样，良性多见。近年来，随着影像学技术的进步以及体检筛查的普及，其检出率呈现出明显的上升趋势，但因其解剖位置深在、毗邻重要神经血管，手术风险较高，治疗方案存在较大争议。如何准确地诊断骶前囊肿并制定合理的治疗方案是影响患者预后和生活质量的关键。目前，国内虽已发布了关于骶前囊肿的专家共识，但是受限于临床发病率低及外科医师的认知差异，其标准化诊疗方案仍存在较大争议。本文系统综述骶前囊肿的临床特征、影像学表现、病理学类型以及主流手术入路，重点探讨骶前囊肿外科治疗中的争议，期望引起临床关注，以推动骶前囊肿的诊疗规范化发展。

Presacral cyst is a category of cystic lesions located in the pelvis between the rectum and the sacrum, exhibiting diverse pathological types with a predominance of benign cases. In recent years, with advancements in imaging technology and the widespread adoption of health screening, its detection rate has shown a significant upward trend. However, due to its deep anatomical location and proximity to critical nerves and blood vessels, surgical intervention carries high risks, and treatment strategies remain highly controversial. Accurate diagnosis of presacral cyst and the formulation of reasonable treatment plans are crucial factors affecting patient prognosis and quality of life. At present, although a domestic expert consensus on presacral cyst has been released in China, standardized diagnostic and therapeutic protocols remain contentious, constrained by the low clinical incidence rate and variations in surgeons' understanding. This article systematically reviews the clinical characteristics, imaging findings, pathological types, and mainstream surgical approaches for presacral cyst. It focuses particularly on the controversies in the surgical management of presacral cyst, aiming to draw clinical attention and enhance the standardization level of diagnosis and treatment of presacral cyst.