藏毛窦的临床诊治

藏毛窦尾均表现为骶尾部脓肿、反复破溃、经久不愈,临床上易误诊误治.彻底手术切除是预防复发的关键,中药及亚甲蓝的使用有利于本病的诊疗.     

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。     

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。     

藏毛窦的手术治疗新进展

藏毛窦和藏毛囊肿（PilonidalsinusandPilonidalcyst）统称为藏毛疾病（Pilonidaldisese）,是在骶尾部臀间裂的软组织内一种慢性窦道或囊肿,内藏毛发是其特征。也可表现为骶尾部急性脓肿,穿破后形成慢性窦道,或暂时愈合,终又穿破,如此可反复发作。囊肿内伴肉芽组织,纤维增生,常含一簇毛。虽在出生后可见此病,但多在青春期后20—30岁发生,因毛发脂腺活动增加,才出现症状。1880年Hodges首次正式命名为藏毛窦,据统计此病在美国发病率较高,近年来在我国亦有上升的趋势。藏毛窦的治疗方法众多,手术治疗为主,目前最为关注的是皮瓣移位及直接减张缝合技术,很多学者对选择皮瓣移位还是直接减张缝合做了大量的研究,在最佳的治疗方案上仍没有一致的观点。本文收集了近几年国外相关方面的最新文献,旨在寻求一种最佳的手术治疗方法。     

骶尾藏毛窦8例

藏毛窦是一种临床少见病，一般在青春旺盛期发病，特别是男性体毛多的患者好发。我院2006～2007年共收治8例藏毛窦，现总结如下。     

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。     

藏毛窦切除＋袋型缝合治愈藏毛窦7例体会

我院自2009年4月-2011年1月共收治藏毛窦患者7例,均采用了藏毛窦切除＋袋型缝合术,现报告如下。     

骶尾部藏毛窦诊治特点

<正>藏毛疾病(pilonidal disease,PD)是多发于臀沟骶尾部的皮下感染~([1]),常反复破溃而形成窦道即藏毛窦。Herbert Mayo于1833年首先描述这种疾病~([2]),1880年Hodges以拉丁语pilus(毛发的)nidus(巢的)将其正式命名为藏毛窦(Pilonidal sinus,PS)~([3]),欧美国家发病率为26/100 000,好发于青春期,危险因素包括男性、多毛体质、肥胖、骶尾部皮肤外伤、久坐等~([4-5])。     

藏毛窦囊肿切除术后伤口感染的影响因素

目的 分析藏毛窦囊肿切除术后伤口感染的影响因素。方法 选取2018年8月至2022年8月在本院行藏毛窦囊肿切除术的藏毛窦囊肿患者80例为研究对象,其中术后Ⅰ期愈合患者61例,伤口发生感染患者19例,对伤口感染患者进行引流液或血液细菌培养,记录病原菌类型及占比,收集所有患者临床资料,采用多因素Logistic回归分析藏毛窦囊肿切除术后伤口感染的影响因素。结果 80例患者中发生伤口感染患者19例,包括革兰氏阴性菌13例,革兰氏阳性菌6例,敞开创面引流换药后均愈合,均经细菌敏感性抗生素治疗3周,部分患者根据病情严重程度口服抗生素。愈合组患者术前病程明显长于感染组,差异具有统计学意义（P<0.05）,两组患者性别、年龄、BMI、囊肿程度比较无差异（P>0.05）。感染组患者术前无脓肿形成、伤口距肛门距离<5 cm患者占比明显高于愈合组患者,差异具有统计学意义（P<0.05）。多因素Logistic回归分析结果显示,术前病程短、术前无脓肿形成、伤口距肛门距离<5 cm为藏毛窦囊肿切除术后伤口感染的独立影响因素（P<0.05）。结论 术前病程短、术前无脓肿形成、...     

Pilonidal Sinus Disease: Risk Factors for Postoperative Complications and Recurrence

The aim of this study is to analyze the risk factors for complications and recurrence in pilonidal sinus disease. The prospective study consisted of 144 patients with pilonidal sinus disease who were operated on at Dicle University Medical Faculty, Department of General Surgery, between February 2008 and December 2010. Patients receiving the Limberg flap totaled 106 (73.6%), while 38 (26.4%) had primary closure. Postoperative complications developed in 42 subjects (29.2%), and recurrence occurred in 19 (13.2%). The Limberg flap method was statistically considered as a risk factor for postoperative complications (P  =  0.039). Regarding recurrence, family tendency (P  =  0.011), sinus number (P  =  0.005), cavity diameter (P  =  0.002), and primary closure (P  =  0.001) were found to be risk factors. Postoperative complication rate is higher in the Limberg flap method than primary closure method. The risk of recurrence is related to family tendency, sinus number, cavity diameter and anesthesia type and is also higher in primary closure.     

美国结直肠外科医师协会《慢性放射性直肠炎临床实践指南》第1版解读

慢性放射性直肠炎是盆腔恶性肿瘤行放射治疗的常见并发症,对其进行规范诊治对改善病人生活质量至关重要。2018年,美国结直肠外科医师协会发布了第1版《慢性放射性直肠炎临床实践指南》,其内容涵盖了慢性放射性直肠炎的预防、诊断及治疗策略,重点论述了现有的常见治疗手段,并对其进行分级推荐,为临床医生规范诊治慢性放射性直肠炎提供了依据。但其对CRP诊疗方法的应用流程和剂量等描述不够具体,尚需高质量的临床研究来得出结论,以更好的指导临床。     

Limberg Flap Versus Primary Closure in the Treatment of Primary Sacrococcygeal Pilonidal Disease; A Randomized Clinical Trial

Pilonidal sinus is a chronic intermittent disease, usually involving the sacrococcygeal area. This study was undertaken to compare the results of rhomboid excision followed by Limberg flap with that of excision and primary closure in patients with primary pilonidal sinus. A total of 120 patients with pilonidal disease were randomly divided into group A who underwent excision and primary closure (n = 60) and group B who underwent the rhomboid transposition flap procedure (n = 60). Length of hospital stay and postoperative complications in two groups were compared. Duration of hospital stay (P < 0.001) and time to resumption of work (P < 0.001) was less for group B, and postoperative complications were fewer in group B (P < 0.05). During follow-up of 2 years, no recurrence was detected in patients in group B, whereas five patients developed recurrence in group A (P = 0.02). Limberg flap procedure is better than the simple excision and primary closure for the management of sacrococcygeal pilonidal disease.     

The Results of a One-Time Crystallized Phenol Application for Pilonidal Sinus Disease

The aim of this study was to investigate the cure rate after a one-time phenol application for pilonidal sinus disease. Forty-eight patients diagnosed with pilonidal sinus from May 2006 to September 2009 were retrospectively reviewed. They were all managed under the same polyclinic conditions in different hospitals by the same surgeon under local anesthesia. Crystallized phenol was applied a total of 97 times on 48 patients. The median follow-up was 22 months (range, six to 38 months). Two patients (4 %) could not participate in the follow-up. One of these patients had 12 sinuses and didn’t continue treatment after eight applications of phenol, and the other had nine sinuses and didn’t continue treatment after five applications of phenol. The one-time application cure rate was 64.5 %, and the rate of success was 95 % with two or more applications. Recurrence did not occur during this period. A one-time phenol application is an effective treatment for pilonidal sinus disease. Hence, it can be an alternative to surgical treatment.     

Minimally Invasive Treatment of Pilonidal Disease: Crystallized Phenol and Laser Depilation

Pilonidal disease has been treated surgically and by various other methods for many years. The most important problem associated with such treatment is recurrence, but cosmetic outcome is another important issue that cannot be ignored. Today, crystallized phenol is recognized as a treatment option associated with good medical and cosmetic outcomes. We hypothesized that the addition of laser depilation to crystallized phenol treatment of pilonidal disease might increase the rate of success, and this study aimed to determine if the hypothesis was true. Patients who were treated with crystallized phenol and 755-nm alexandrite laser depilation were retrospectively analyzed. In total, 42 (31 male and 11 female) patients were treated with crystallized phenol and alexandrite laser depilation and were followed up between January 2009 and January 2012. In all, 38 patients (90.5%) had chronic disease and 4 (9.5%) had recurrent disease. Among the patients, 26 (61.9%) recovered following 1 crystallized phenol treatment, and the remaining patients had complete remission following repeated treatment. Some patients needed multiple treatments, even up to 8 times. None of the patients had a recurrence during a mean 24 months (range, 6–30 months) of follow-up. Whatever method of treatment is used for pilonidal disease, hair cleaning positively affects treatment outcome. The present results support the hypothesis that the addition of laser depilation (which provides more permanent and effective depilation than other methods) to crystallized phenol treatment (a non-radical, minimally invasive method associated with very good cosmetic results) can increase the effectiveness of the treatment and also reduce the recurrence rate of the disease.     

Treatment of Malignancy Arising in Pilonidal Disease

Background: Malignant degeneration is a rare complication of pilonidal disease and is associated with a high recurrence rate and poor prognosis compared with regular nonmelanoma skin cancer. Treatment in our departments and in the international literature was evaluated.Methods: We analyzed the data from three patients with malignant degeneration who were treated in our departments and an additional 56 patients who were found after an extensive literature search.Results: A total of 47 males and 12 females, with a mean age of 52 years, were most frequently primarily treated with surgery. After a mean follow-up time of 28 months, 20% of all patients died with evidence of disease and an additional 10% died of unrelated causes. The overall recurrence rate was 39%, with a median time to recurrence of only 9 months. The local recurrence rate was lower when radiotherapy was added to surgical treatment alone (30% vs. 44%). Re-excision of local recurrence resulted in some long-term survivals.Conclusions: Early diagnosis and treatment may lead to improvement of the relative poor prognosis. Surgical treatment should be tailored according to the locoregional extent. The high recurrence rate after surgical treatment can be reduced by the addition of radiotherapy. Although repeat surgery for recurrent disease may involve extensive resection and morbidity, this may result in prolonged survival.     

Treatment options for perianal Bowen's disease: survery of American Society of Colon and Rectal Surgeons Members

The aim of this study was to determine current management practices of physicians caring for patients with perianal Bowen's disease. A questionnaire was sent to 1,499 members listed in the 1997 American Society of Colon and Rectal Surgeons Directory asking them how many patients they have treated and which operative or nonoperative treatment option they choose for small (< or =3 cm), large (> 3 cm), and microscopic lesions. Of 1,499, 663 (44.2%) surgeons responded. Not all respondents answered each item. Seventy-five per cent of surgeons surveyed (n = 653) devote greater than 75 per cent of their practice to colon and rectal surgery. Of 642 respondents, 552 (86%) managed a total of <10 patients, and 90/642 (14%), > or =10 patients. Ninety-six per cent of respondents use wide local excision for patients with small lesions. Eighty-seven per cent of respondents use wide local excision for patients with large lesions. Seventy-four per cent treat patients with microscopic disease conservatively and without wide excision. The majority of surgeons caring for patients with perianal Bowen's disease are performing wide local excision for both small and large lesions. Microscopic disease was usually treated conservatively with observation alone.     

Laser epilation is a safe and effective therapy for teenagers with pilonidal disease

Pilonidal disease (PD) is a frustrating condition because of a recurrence rate as high as 30%. Hair insertion is the essential cause of the disease. Therefore, hair removal with shaving is a part of many postoperative regimens. These methods are resource intensive and adversely impact the life-style of both patient and family. Therefore, we investigated the use of laser epilation (LE) of the intergluteal hair in adolescents with PD as a method of permanent hair removal.

Methods

A retrospective review of all patients with PD who underwent LE from 2003 to 2006 at the National Naval Medical Center, Bethesda, Md, and Walter Reed Army Medical Center, Washington, DC, was performed. Laser epilation of the intergluteal hair was carried out with a 1064 nm Nd:YAG laser (Coolglide Vantage, Altus/Cutera, Brisbane, Calif) at a standard fluence (joule/square centimeter), pulse duration, and repetition rate based on skin phototype. The patients were observed for hair regrowth and recurrence.

Results

Twenty-eight teenagers (17 males, 11 females; mean age, 17.2 ± 1.4 years) underwent LE. Eight patients presented with abscess and were managed by incision and drainage followed by excision and open wound management, 17 patients presented with a cyst or sinus and underwent excision and primary closure, and 3 patients with asymptomatic sinus were managed nonoperatively. Laser epilation was performed after complete wound healing or immediately in those patients with asymptomatic sinus disease. Laser epilation was well tolerated and without complication in all patients. Intergluteal hair was completely removed in all patients. Patients required an average of 5 ± 2 LE therapy sessions for hair removal. All patients underwent at least 3 LE sessions (range, 3 to 7 sessions) at 4-week intervals. One female developed a recurrence. The mean follow-up for the group was 24.2 ± 9.9 months.

Conclusions

Laser epilation is a safe method to remove intergluteal hair in teenagers with PD. This technique is an effective adjunctive therapy for the treatment of PD that may reduce recurrence.