负压封闭引流术在藏毛窦手术切除术后创面修复中的应用价值

Application value of vacuum sealing drainage in the wound repair after resection of pilonidal sinus

目的：探讨负压封闭引流术（VSD）在藏毛窦手术切除术后创面修复中的应用价值。方法： 采用回顾性横断面研究方法。收集2015年4月至2016年6月吉林大学中日联谊医院收治的11例藏毛窦患者的临床资料。11例患者术前使用抗生素治疗后，均行手术切除治疗藏毛窦，术后行VSD，常规抗感染和换药治疗。观察指标：（1）治疗情况：手术方式、手术时间、术中出血量、大体标本情况、术后病理学检查结果、术后治疗情况（使用VSD材料情况）、肉芽组织生长情况、住院时间、治疗费用。（2）随访情况：获得随访的患者人数、随访时间、创面愈合情况、术后并发症、疾病复发情况。采用门诊和电话方式进行随访，随访内容包括创面愈合情况、术后并发症、疾病复发情况。随访时间截至2017年7月。正态分布的计量资料以±s表示，偏态分布的计量资料采用M（范围）表示。 结果：（1）治疗情况：11例患者均成功施行藏毛窦切除术，手术时间为（79±19）min，术中出血量为（10±4）mL。11例患者手术切除后大体标本观察显示： 7例切除病灶内含毛发，4例不含。11例患者术后病理学检查结果均显示：上皮下纤维组织内急慢性炎症伴异物肉芽组织，散在多核巨细胞反应。11例患者术后均行VSD，9例更换了3次VSD材料，2例更换了 1次VSD材料，拆除VSD材料后创面均未行缝合。11例患者术后（5.9±1.3）d创面可见新生肉芽组织生长。11例患者住院时间为（33.3±8.3）d，治疗费用为（37 790±8 811）元。（2）随访情况：11例患者均获得随访，随访时间为12～18个月，中位随访时间为14个月。11例患者创面愈合时间为（41.0±9.0）d ，其中10例创面术后一期愈合，1例术后2个月切口感染伴切口深面脓肿形成，行骶尾部创面切开引流，切口填塞纱布，常规换药后创面完全愈合。11例患者随访期间均未见疾病复发。结论：VSD应用于藏毛窦手术切除术后创面修复中，创面感染发生率低，愈合后瘢痕组织小。VSD尤其适合于藏毛窦手术切除术后创面大，张力高，感染重的患者。

Objective：To explore the application value of vacuum sealing drainage （VSD） in wound repair after resection of pilonidal sinus. Methods：The retrospective crosssectional study were conducted. The clinical data of 11 patients with pilonidal sinus who were admitted to the ChinaJapan Union Hospital of Jilin University from April 2015 to June 2016 were collected. All the patients received resection of pilonidal sinus after preoperative antibiotic therapy, and then received postoperative VSD and regular treatments of antiinfection and dressing changes. Observation indicators： （1） treatment situations： surgical procedures, operation time, volume of intraoperative blood loss, gross specimens, results of postoperative pathological examination, postoperative treatment （VSD）, growth condition of granulation tissue, duration of hospital stay and treatment expenses; （2） followup situations： cases with followup, followup time, wound healing, postoperative complications and disease recurrence. Followup using outpatient examination and telephone interview was performed to detect the wound healing, postoperative complications and disease recurrence up to July 2017. Measurement data with normal distribution were represented as ±s. Measurement data with skewed distribution were described as M（range）. Results：（1） Treatment situations： all the 11 patients underwent successful surgery for pilonidal sinus. The operation time and volume of intraoperative blood loss were respectively （79±19）minutes and （10±4）mL. Observation of gross specimens of 11 patients： hairs were scattered within the resected lesions in 7 patients, and hairs didn＇t found in 4 patients. Results of postoperative pathological examination of 11 patients： there were acute and chronic inflammation accompanied with granulation tissues in the subepithelial fibrous tissues, and discrete multinucleated giant cell reaction. Of 11 patients undergoing VSD, 9 received VSD material changes for 3 times, 2 received VSD material changes for once, and wounds were not sutured after VSD removal. The new granulation tissues of 11 patients were found at （5.9±1.3）days postoperatively. The duration of hospital stay and treatment expenses were respectively （33.3±8.3）days and （37 790±8 811）yuan. （2） Followup situations： 11 patients were followed up for 12-18 months, with a median time of 14 months. The wound healing time was （41.0± 9.0）days. Of 11 patients with followup, 10 were in the primary healing, 1 who was complicated with wound infection and abscess of wound deep surface underwent sacral wound incision and drainage, gauze packing and routine dressing change, and then wound healed completely. There was no recurrence in 11 patients during the followup. Conclusions：The VSD has great application value in managing wounds after resection of pilonidal sinus, with a lower incidence of wound infection and smaller scar, and it is worth recommending to patients with wide wounds, high tension and serious infection.