双改良Limberg转移皮瓣治疗骶尾部藏毛窦的短期临床疗效

Short-term clinical outcomes of double-modified Limberg flap transplantation in treatment of sacrococcygeal pilonidal sinus

目的探讨双改良Limberg转移皮瓣在治疗骶尾部藏毛窦中的效果。方法纳入2010年10月至2015年5月期间中国医科大学附属盛京医院收治的100例骶尾部藏毛窦患者,分为双改良Limberg转移皮瓣组(简称"双改良皮瓣组",n=30)、经典Limberg转移皮瓣组(简称"经典皮瓣组",n=30)及直接间断缝合组(简称"间断缝合组",n=40)3组。对3组患者的手术时间、术中出血量、住院时间、返回工作时间、复发情况及术后切口并发症发生情况进行对比分析。结果 1 3组患者的年龄、性别、体质量指数及术前并发症情况比较差异均无统计学意义(P>0.05)。2术中出血量和住院时间在3组患者间比较差异均无统计学意义(P>0.05)。手术时间在双改良皮瓣组和经典皮瓣组均明显长于间断缝合组(P<0.05),双改良皮瓣组和经典皮瓣组间比较差异无统计学意义(P>0.05)。返回工作时间在双改良皮瓣组和经典皮瓣组均明显短于间断缝合组(P<0.05),双改良皮瓣组和经典皮瓣组间比较差异无统计学意义(P>0.05)。复发率在双改良皮瓣组和经典皮瓣组明显低于间断缝合组(P<0.05),双改良皮瓣组和经典皮瓣组间比较差异无统计学意义(P>0.05)。3术后切口血清肿和切口部分裂开的发生率在3组患者间比较差异均无统计学意义(P>0.05)。术后切口感染发生率在双改良皮瓣组和经典皮瓣组均明显低于间断缝合组(P<0.05),双改良皮瓣组和经典皮瓣组间比较差异无统计学意义(P>0.05)。术后切口浸渍率在双改良皮瓣组和间断缝合组均明显低于经典皮瓣组(P<0.05),双改良皮瓣组和间断缝合组间比较差异无统计学意义(P>0.05)。切口完全裂开率在双改良皮瓣组和经典皮瓣组均明显低于间断缝合组(P<0.05),双改良皮瓣组和经典皮瓣组术后均无切口完全裂开者。双改良皮瓣组和经典皮瓣组均无皮瓣坏死发生。结论无论采用哪种转移皮瓣治疗骶尾部藏毛窦均有效,其较传统直接间断缝合有更低的切口并发症发生率,更短的返回工作时间,更低的复发率,而经典Limberg皮瓣较双改良Limberg皮瓣有较高的切口浸渍发生率。由于本研究的样本量比较少,双改良Limberg皮瓣技术长期临床疗效尚需要多中心随机对照试验来进一步证实。

Objective To investigate short-term clinical outcomes of double-modified Limberg flap transplantation in treatment of sacrococcygeal pilonidal sinus. Methods One hundred patients with sacrococcygeal pilonidal sinus from October 2010 to May 2015 in this hospital were included, and subsequently were divided into double-modified Limberg flap transplantation group （double-modified flap group, n=30）, classical Limberg flap transplantation （classical flap group, n=30）, and interrupted suture after resection group （interrupted suture group, n=40）. The duration of operation, intraoperative bleeding, hospital stay, duration of return to work, recurrence rate, and incision complications rate were compared among these three groups. Results ① The age, gender, body mass index, and preoperative complications had no significant differences among these three groups （P〉0.05）. ② The intraoperative bleeding and the hospital stay had no significant differences among these three groups （P〉0.05）. Compared with the interrupted suture group, the durations of operation were significantly longer （P〈0.05）, the durations of return to work were significantly shorter （P〈0.05）, the recurrence rates were significantly lower （P〈0.05） in the double-modified flap group and the classical flap group. The above indicators had no significant differences between the double-modified flap group and the classical flap group （P〉0.05）.③The incision hematoma and the part disruption of incision had no significant differences among these three groups （P〉0.05）. Compared with the interrupted suture group, the rates of incision infection and incision complete disruption were significantly lower （P〈0.05） in the double-modified flap group and in the classical flap group. The incision maceration of the classical flap group was significantly higher than that of the interrupted suture group （P〈0.05） or the double-modified flap group （P〈0.05）. No skin flap necrosis occurred in the double-modified flap group and the classical flap group. Conclusions Double-modified Limberg flap transplantation and classical Limberg flap transplantation have less complications and lower recurrence rate than interrupted suture after resection. Compare with classical Limberg flap transplantation, double-modified Limberg flap transplantation has a lower incision maceration rate. Because of limitation of sample size in this study, long-term clinical efficacy of double-modified Limberg flap transplantation needs to be confirmed by multicenter randomized controlled trials.