藏毛窦外科治疗体会

Experience of surgical treatment in pilonidal sinus

目的:探讨藏毛窦的手术方法及治疗效果。方法:回顾性分析2012-01-01～2017-12-31我院结直肠肛门外科收治的藏毛窦患者73例的临床资料,所有患者均接受手术治疗,其中切除后直接缝合切口41例(直接缝合组)、切除后切口开放13例(切口开放组)、切除后皮瓣转移19例(皮瓣转移组)。结果:直接缝合组和皮瓣转移组切口愈合时间均明显短于切口开放组(P<0.05),直接缝合组与皮瓣转移组间差异无统计学意义(P>0.05)。直接缝合组并发切口部分裂开2例,切口感染6例;切口开放组出现切口感染1例;皮瓣转移组皮瓣部分坏死2例,切口感染1例。切口愈合后随访1年均无复发。结论:藏毛窦切除直接缝合术术后愈合时间短、恢复快、痛苦小,是理想的手术方式。但对于囊肿较大、窦道较长、创口张力较大及组织缺损较多的患者,可行皮瓣转移。如囊肿感染比较严重的则选择切口切开不予缝合,这样引流彻底不易复发。

Objective:To investigate the surgical methods and clinical effects for pilonidal sinus.Methods:The clinical data of 73 patients with pilonidal sinus treated from January 2012 to December 2017 were analyzed retrospectively.All of them were received surgery,41 patients underwent direct suturing after pilonidal sinus resection(direct suturing group),13 patients underwent pilonidal sinus resection alone(incision open group),and 19 patients underwent skin flap transposition after pilonidal sinus resection(flap transposition group).Results:The healing time in the direct suturing group and flap transposition group was less than that in the incision open group(P<0.05),and there was no significant difference between the direct suturing group and flap transposition group(P >0.05).Two patients accurred wound disruption and six patients accurred wound infection in direct suturing group,one patients accurred wound infection in incision open group,two patients accurred skin and subcutaneous tissue necrosis and one patients accurred wound infection in flap transposition group.There was no recurrence after the wound healing of follow-up one year.Conclusion:Direct suturing in treatment of pilonidal sinus has many advantages,such as faster recovery,less pain,shorter wound healing.But for those larger cyst,sinus longer and larger wound,the flap transposition is more secure.For severe cyst infection,incision drainage is fit.