巨大骶尾部藏毛窦8例临床分析

为探讨巨大骶尾部藏毛窦的手术方法和治疗特点,回顾性分析手术治疗的8例巨大骶尾部藏毛窦,总结诊断、于术入路、手术方式及治疗效果。结果显示,藏毛窦完全切除6例,部分切除2例。术后病理为异物性肉芽肿,随访时间11个月至10年,术后创1：3感染2例,复发1例。结果表明,术前应进行全面评估,蛛网膜下腔或连续硬膜外麻醉、骶尾部入路、低电量电刀剥离是切除巨大骶尾部藏毛窦的最佳方法,彻底手术切除是预防复发的关键。     

骶尾部藏毛窦84例诊治体会

目的总结骶尾部藏毛窦的诊断和治疗方法。方法回顾性分析我院2007年1月至2011年1月期间收治的84例骶尾部藏毛窦病例的诊治过程,并结合国内、外相关文献报道进行分析、总结。对骶尾部藏毛窦复发者及瘘道走形长度大于5 cm者采用窦道切除切口敞开术,完整切除病变组织,予以康复新液纱条每日湿敷换药治疗;无复发者且瘘道走形长度小于5 cm者采用切除一期缝合,切口褥式缝合,消灭死腔。结果采用切除一期缝合术者36例,窦道切除切口敞开术者48例。有2例切除一期缝合术者术后半年复发,行窦道切除切口敞开术后以康复新液换药而愈;其余82例均一次性手术治愈。切除一期缝合的伤口愈合时间为14～35 d,平均为26 d;窦道切除切口敞开愈合时间为30～45 d,平均37 d。无一例发生并发症。随访1年以上均无复发。结论术前完善相关检查,明确诊断,根据病情选择合适的手术治疗方式,以及围手术期的合理护理能最大程度地治愈及减少复发的可能性。     

改良V-Y皮瓣成型术治疗骶尾部藏毛窦

目的探讨改良V-Y皮瓣成型术在骶尾部藏毛窦治疗中的效果。方法回顾性分析2011~2014年期间我院采用切除窦道、改良V-Y皮瓣成型术治疗的12例骶尾部藏毛窦患者的临床病例资料。结果 12例患者均一期愈合,无皮瓣坏死、皮下血肿及切口裂开,随访1~4年,均无复发。结论从本组有限的病例资料结果来看,改良V-Y皮瓣成型术治疗骶尾部藏毛窦效果较好,操作简单,术后美观。     

Ⅰ期切除缝合治疗骶尾部藏毛窦25例分析

目的探讨Ⅰ期切除缝合治疗骶尾部藏毛窦的手术方法及治疗效果。方法对25例骶尾部藏毛窦行Ⅰ期切除缝合手术治疗的临床资料进行回顾总结性分析。结果全组除1例术后5月复发外均治愈,无手术意外损失及严重并发症,住院时间12～16天,术后随访6月～1年,无窦道复发。结论Ⅰ期切除缝合治疗藏毛窦具有手术切除彻底、复发率低、愈合时间短、缩短住院周期的优点。     

袋形缝合术联合中药外敷治疗骶尾部藏毛窦13例报道

目的探讨袋形缝合术联合中药外敷治疗骶尾部藏毛窦的临床疗效。方法应用袋形缝合术联合中药外敷治疗骶尾部藏毛窦13例。结果13例患者全部治愈,随访1年,未见明显复发及并发症。结论袋形缝合术联合中药外敷治疗骶尾部藏毛窦手术操作简单,治疗彻底,缩小了手术创面,愈合时间相对缩短,复发少,患者痛苦少,长期效果优良,治疗骶尾部藏毛窦安全、有效,值得临床推广应用。     

病灶切除敞开创面联合邮票植皮术治疗骶尾部藏毛窦的疗效分析

目的介绍骶尾部病灶切除敞开创面联合邮票植皮治疗骶尾部藏毛窦的手术方法并总结其疗效。方法在2008年6月至2015年9月间,广州中医药大学第一附属医院收治的26例骶尾部藏毛窦病人在腰硬联合麻醉下行病灶切除敞开创面联合邮票植皮术,记录手术时间,术后观察病人并发症情况、住院及愈合时间,并对病人进行随访,观察复发率。结果平均手术时间为25.8min;术后当晚仅有1例病人因疼痛肌注曲马多止痛,无病人出现切口感染;病人住院时间为13~16 d,平均完全愈合时间为术后15.4 d;术后随访时间为3~14个月,无病人出现疾病复发。结论病灶切除敞开创面联合邮票植皮术治疗藏毛窦疗效满意,相比其他治疗骶尾部藏毛窦的手术,具有手术简单、疼痛程度轻、住院时间短、复发率低、复发后不增加再次手术难度等显著优点,值得研究推广。     

藏毛窦外科治疗的疗效分析

目的探讨骶尾部藏毛窦外科治疗方法。方法回顾性分析2007年7月至2014年2月南京中医药大学第一附属医院收治的骶尾部藏毛窦33例患者的临床资料,其中18例行藏毛窦切除+袋形缝合术,15例行藏毛窦菱形切除+Limberg皮瓣转移术。结果18例行藏毛窦切除+袋形缝合术经一次手术治愈。15例行藏毛窦菱形切除+Limberg皮瓣转移术均痊愈,其中5例出现切口部分裂开或坏死延迟愈合,均经常规换药引流后愈合。藏毛窦菱形切除+Limberg皮瓣转移术愈合时间较藏毛窦切除+袋形缝合术短[(19±7)d比(37±12)d,t=6.556,P<0.01].袋形缝合术组术后复发1例,复发率5.6%,Limberg皮瓣转移术组术后无1例复发,2组复发率相比差异无统计学意义(P>0.05)。结论藏毛窦菱形切除+Limberg皮瓣转移术与藏毛窦切除+袋形缝合术均可有效治疗藏毛窦,对于复杂性和复发病例尽可能选择皮瓣转移技术。     

菱形切除Limberg皮瓣转移术与切除一期缝合术治疗骶尾部藏毛窦疗效评价

比较菱形切除Limberg皮瓣转移术与切除一期缝合术治疗骶尾部藏毛窦的疗效。回顾性分析中国医科大学附属第四医院肛肠科2007年1月—2013年6月收治的122例接受两种不同术式治疗的骶尾部藏毛窦患者,其中藏毛窦菱形切除Limberg皮瓣转移术58例(皮瓣组),藏毛窦切除一期缝合术64例(缝合组)。随访12~89个月(平均43.6个月),比较两组的术后疼痛评分、手术时间、住院时间、切口愈合时间、复发及并发症的发生率。皮瓣组的术后疼痛评分、切口愈合时间、复发及并发症发生率均少于缝合组(P0.05);皮瓣组手术时间大于缝合组(P0.05);两组住院时间差异无统计学意义(P0.05)。菱形切除Limberg皮瓣转移术除了手术时间相对较长以外,操作并不复杂,术后疼痛轻、切口愈合时间短、并发症少、复发率低,值得临床推广。     

两种手术方法治疗骶尾部藏毛窦 43例的临床分析

目的:评价切开引流囊壁搔刮术与切除袋形缝合术治疗骶尾部藏毛窦的疗效。方法:回顾性分析43例骶尾部藏毛窦患者的临床资料,其中行切开引流囊壁搔刮术治疗(切口开放搔刮组)20例,行切除袋形缝合术治疗(切除袋形缝合组)23例。结果:切口开放搔刮组、切除袋形缝合组的手术时间分别为(30.40±5.22)min、(43.49±7.45)min,住院时间分别为(7.70±1.42)d、(8.17±1.47)d,愈合时间分别为(34.45±7.72)d、(24.48±5.96)d,术后疼痛NRS评分分别为(4.15±1.09)、(4.74±0.96)。两组手术时间、切口愈合时间的差异具有统计学意义(P<0.05),住院时间、术后疼痛的差异无统计学意义(P>0.05)。随访1~6年,两组均无复发。结论:彻底切除病变组织是治愈骶尾部藏毛窦的关键,急性感染期选择切开引流囊壁搔刮术、慢性窦道期选择切除袋形缝合术均可治愈骶尾部藏毛窦。     

骶尾部藏毛窦21例治疗体会

目的 比较骶尾部藏毛窦切除后袋形缝合和一期缝合的临床疗效.方法 2007年至2012年我院收治藏毛窦患者并分别进行藏毛窦切除后袋形缝合术或一期缝合手术21例,其中12例采用袋形缝合,9例采用一期缝合.结果 藏毛窦切除后袋形缝合平均创面愈合时间（33.50±19.45）d,袋形组未见明显术后并发症,无复发;一期缝合平均创面愈合时间（27.33±17,16）d,2例术后感染,切开引流,二期愈合,1例出现术后感染后创面未愈,再次手术治愈,1例创面轻微裂开,复发1例（11.1％）.结论 藏毛窦切除后袋形缝合,术后并发症发生率低及复发率低,一期缝合的优点是创面愈合快,但是应当考虑到患者感染率较高的问题.     

Multiple Z-Plasty in Pilonidal Sinus—A New Technique under Local Anesthesia

Background Pilonidal sinus is a common surgical condition. Though benign, it causes a lot of distress with its associated morbidity and financial loss to the patient. Many procedures have been tried, ranging from nonsurgical to surgical methods (both conservative and radical ones). It is well known that recurrences are low when the scar is away from the midline. Materials and Methods The author has described a new technique of multiple Z-plasty for the treatment of pilonidal sinus that has been effective in the cure of this problem. This article reports a prospective, nonrandomized noncomparative preliminary clinical study of 115 cases of pilonidal sinus operated on by the author over 14 years. Results The results were compared with the results of other methods mentioned in the literature. There were only two recurrences. Conclusions The author proposes that multiple Z-plasty can be considered as an option in the surgical treatment of pilonidal sinus.     

A new flap for reconstruction of pilonidal sinus: lumbar adipofascial turnover flap

BACKGROUND: "Adipofascial turnover flap" is a well-known procedure, but it is generally not used for the surgical treatment of pilonidal sinus disease. The "lumbar adipofascial turnover flap" has been used in this study for the reconstruction of uncomplicated pilonidal sinus disease. METHODS: Ten cases (8 male and 2 female patients) were operated on by this technique. The reconstruction was performed with the lumbar adipofascial turnover flap. The flap sizes ranged from 4 x 7 cm to 5 x 9 cm (mean, 4.5 x 8 cm), and they were elevated with length-to-base ratio below 2:1. The follow-up period was 14 to 26 months. RESULTS: Postoperative magnetic resonance imaging, computed tomography scan, and power Doppler ultrasound examinations revealed viability of the flaps in all patients. There was no distortion of anatomic landmarks in any of the cases. The esthetic results were satisfying for all patients as well. There was no recurrence in any cases. CONCLUSIONS: The hospital stay and mean time off work were shorter compared with other methods of reconstruction and there was no recurrence. We advocate that the lumbar adipofascial turnover flap is an excellent choice for reconstruction of cases with uncomplicated pilonidal sinus disease.     

直肠腔内超声对骶尾部藏毛窦的诊断价值

目的：探讨直肠腔内超声对骶尾部藏毛窦的诊断价值。方法：采用6．5兆直肠棒状腔内探头，分别放置于肛周、骶尾部及肛管直肠腔内作连续探查，分析超声图象特点，结合临床，诊断骶尾部藏毛窦9例。结果：9例直肠腔内超声诊断为骶尾部藏毛窦，经手术及病理均证实。结论：直肠腔内超声对于骶毛部藏毛窦的诊断非创伤性，操作简便、快捷，有较好地诊断推广价值。     

藏毛窦7例临床分析

为探讨藏毛窦的发病、诊断与治疗,回顾性分析7例藏毛窦患者的临床资料。结果显示,7例病变窦口均位于肛门后正中即臀沟处,有反复感染、破溃流脓、经久小愈病史,采用一期切除缝合术,达到一期愈合。结果表明,藏毛窦好发于中青年男性,病程中有反复急性发作,手术彻底切除是治愈的关键。     

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目的 探讨藏毛疾病的诊断和治疗方法。方法 回顾分析1991-2001年收治的10例藏毛疾病病人的临床资料。结果 10例藏毛疾病中藏毛窦9例，藏毛囊肿1例。10例病人均反复发作骶尾部感染，仅2例在瘘口内发现毛发，1例发现尾骨缺损。10例均经手术治疗，术后病理为异物性肉芽肿，随访时间1～11年，均无复发。结论 藏毛疾病容易误诊，术前应进行全面评估，彻底手术切除是预防复发的关键。     

Umbilical Pilonidal Sinus Disease: Predisposing Factors and Treatment

Pilonidal sinus disease is a common problem of sacrococcygeal region. However, it is also observed in the periumbilical area. There are only a few reports about umbilical pilonidal sinus in the literature. In this study, 26 patients (24 men (92 %), 2 women (8 %) with a mean age of 22 years) with umbilical pilonidal sinus disease were included. Predisposing factors, patient characteristics, treatment modalities, and their results have been studied. Male sex, young age, hairiness, deep navel, and poor personal hygiene were found to be predisposing factors. Twenty-five patients were treated conservatively. However, two patients failed to respond to conservative treatment. Those patients underwent surgery where umbilectomy was carried out without reconstruction. One patient was also operated on for the preoperative misdiagnosis of irreducible umbilical hernia. Patients were followed for 14–96 months. We recommend conservative treatment in patients with umbilical pilonidal sinus. Surgery should be performed in recurrent cases resistant to conservative treatment. The importance of differential diagnosis of umbilical pilonidal sinus from other umbilical pathologies is also emphasized.     

潜毛囊肿和潜毛窦的诊断治疗

目的分析潜毛囊肿和潜毛窦的诊断和治疗。方法回顾性分析8例少见病例——潜毛囊肿和潜毛窦的临床经过,结合国内外的相关报道进行分析。结果 8例潜毛囊肿和潜毛窦患者中,4例诊断明确,进行手术切除治疗,疗效满意。3例曾误诊为肛旁脓肿切开引流、1例以穿刺引流误治,均形成窦道经久不愈。后经CT明确为潜毛囊肿或潜毛窦,进行肿瘤切除一期缝合痊愈。结论潜毛囊肿和潜毛窦在临床上是少见病,手术彻底切除肿瘤是唯一治疗方法。     

Expression of Epstein–Barr virus in children with sacrococcygeal pilonidal sinus determined by immunohistochemical methods

In this study, we probed whether chronic infections of skin such as pilonidal sinus could be a potential site of Epstein–Barr virus (EBV) replication. Pilonidal sinus is associated with a high recurrence rate. Therefore, we decided to determine the role of EBV's presence to explain whether it is correlated with the recurrence of pilonidal sinuses. This study was conducted on 36 patient samples with sacrococcygeal pilonidal sinus. Samples were immunohistochemically stained for EBV, CD3 and CD20 expression. Thirty‐six adolescents with pilonidal disease were evaluated. EBV‐positive cells were located in dermis with high inflammatory activity. EBV‐positive cells stained positive for the B‐cell antigen CD20 and were detected in 10 of 36 (27%) pilonidal sinus specimens. Among those who had experienced a relapse, three were positive for EBV expression. In addition, EBV expression was detected in eight cases with severe inflammation, and in two with minimal or moderate inflammation. Our study advances the field by demonstrating that similar to gastrointestinal mucosa, skin could be a reservoir for EBV. EBV was found to be restricted to B cells in skin lesions, and it was found that skin lesions with severe inflammation showed higher frequency of EBV expression in comparison to minimal or moderately inflammed skin lesions. Additionally, recurrence was more frequently observed among EBV‐positive cases. These findings point out for a role of EBV infection in the recurrence of pilonidal sinuses.