挂线引流结合手术切除治疗头部脓肿性穿掘性毛囊周围炎的临床效果

Clinical effects of excision and setons drainage management in treatment of early and medium-term perifolliculitis capitis abscedenset suffodiens

目的探讨头部脓肿性穿掘性毛囊周围炎的手术治疗方式。方法2015年6月至2018年10月,山东省栖霞市中医院皮肤科收治头部脓肿性穿掘性毛囊炎患者8例,年龄13~26岁,平均23岁。病程0.5~5年,脓腔直径0.5~4.0 cm。手术完整切除病变毛囊及炎症浸润的周围组织,深达脂肪层。窦道两端,脓腔两侧,放入橡皮引流条,将引流条两端对合结扎。结果8例患者术后每日换药,并配合静脉滴注抗生素(头孢呋辛)至创面愈合,8例患者术后均恢复良好。细菌培养金黄色葡萄球菌。1例患者术后1个月头皮出现数个小丘疹,疼痛,外涂聚维酮碘后丘疹消退,其余7例患者随访至2018年11月均未见复发。结论头部脓肿性穿掘性毛囊周围炎治疗困难,包括抗生素、维A酸、生物制剂、光动力、激光、手术等效果均欠佳。挂线引流结合手术切除是治疗头部脓肿性穿掘性毛囊炎的有效治疗方法。

Objective To investigate the surgical management of perifolliculitis capitis abscedenset(PCAS).Methods From June 2015 to October 2018,8 patients with PCAS were treated,aged 13-26 years,with an average age of 23 years.Hypepigmented plaques in size were from 0.5-4.0 cm.The operative technique was based on the complete excision of the entire diseased skin and subcutaneous fatty tissue,the fistula was explored using a probe,the seton was inserted through the remaining tract in a double-strand fashion,this double-strand elastic seton was then tied over itself without excessive tension.The wound was covered with absorptive dressing.Results All the wounds in 8 patients healed primarily.All patients were followed up for 6 months and showed no recurrence after surgery.Conclusions Perifolliculitis capitis abscedens et suffodiens scalp is a rare chronic suppurative skin disease,its etiology and pathogenesis are unclear,but related with follicular atresia,bacterial infection,immune factors,sex hormones,smoking and obesity.The treatment is difficult,including antibiotics,vitamin A acid,biological agents,photodynamic,laser and surgery.The disease is stubborn and refractory.The technique of wide surgical excision and loose setons drainage is an effective method for PCAS.