外科治疗骶尾部藏毛窦68例

Surgical treatment experience of 68 patients with sacrococcygeal pilonidal sinus

目的：探讨骶尾部藏毛窦两种不同切口处理方法的临床效果,为其临床诊治提供理论依据。方法：回顾性分析我院自2008年1月至2014年1月期间收治并得到完整随访的68例骶尾部藏毛窦,将其分为一期缝合组和创口敞开组,观察2组患者的性别、年龄、体质量指数（BMI）、囊肿大小（最大径×最小径）、窦道长度、囊肿距肛缘距离、外窦口数量、既往手术次数、手术创口大小（横径×纵径）、创口愈合时间和术后并发症的差异。结果：一期缝合组30例,其中男26例,女4例;创口敞开组38例,其中男31例,女7例。全组平均BMI为25.02 kg/m^2。一期缝合组创口愈合时间为14-29 d;创口敞开组创口愈合时间为16-67 d。一期缝合组和创口敞开组分别有1例于术后1年内复发。一期缝合组有1例切口感染,发生率为3.33%;创口敞开组有2例患者出现创口感染,发生率为5.26%。2组患者性别、年龄、病程长短、距肛缘距离、外窦口数量及既往手术次数差异均无统计学意义（P〉0.05）;而囊肿大小、窦道长度、皮肤创口大小及创口愈合时间差异均有统计学意义（P〈0.05）。结论：藏毛窦窦道切除一期缝合术后恢复快、痛苦小,是理想的手术方式。但对于那些囊肿较大、窦道较长、创口张力较大及组织缺损较多的患者,创口敞开充分引流更为稳妥。

Objective： To summarize the methods of diagnosis and treatment for sacrococcygeal pilonidal sinus. Methods： The processes of diagnosis and treatment for 68 patients with sacrococcygeal pilonidal sinus were analyzed retrospectively. They were divided into the sinus resection and primary suture group, and the sinus resection and incision open group. The difference of two groups was observed in gender, age, body mass index（BMI）, the cyst size, the sinus length, the distance from the anal verge cyst, the number of external ports, the number of previous surgery, the surgical wound size, the wound healing time and the postoperative complications. Results： The primary suture group of 30 patients included 26 males and 4 females. The incision open group of 38 patients included 31 males and 7 females. The average BMI（BMI） was 25.02 kg/ m^2 in total. The wound healing time of the primary suture group was 14-29 d. The other group was 16-67 d. One case of the primary suture group developed wound infection, the incidence of infection was 3.33%; the other group, 2 patients had wound infection, the incidence was 5.26%. The difference in gender, age, the sick time, the distance from the anal margin, the number of external ports and previous sinus surgery had no significant in two groups（P〉0.05）; while the differences in the cyst size, the sinus length, the surgical wound size and the wound healing time were statistically significant（P〈0.05）. Conclusion： The incision and primary suture is the ideal surgery. Because it has many advantages, such as faster recovery, less pain, shorter wound healing and so on. But for those larger cyst, sinus longer and larger wound, the sinus resection and incision open is more secure.