Petersen Sven, Koch Rainer, Stelzner Sigmar, Wendlandt Thomas-Peter, Ludwig Klaus
Department of General and Abdominal Surgery, General Hospital Dresden-Friedrichstadt, Teaching Hospital--Technical University of Dresden, Friedrichstrasse 41, Dresden, Germany 01067.
Dis Colon Rectum. 2002 Nov;45(11):1458-67. doi: 10.1007/s10350-004-6451-2.
Pilonidal sinus is a common disease and surgical removal and subsequent wound closure is crucial for lasting cure. To evaluate the outcome of different primary closure techniques we performed a pooled analysis of data published in the past 35 years.
We identified reports on wound infection, early failure, and late recurrence status in relation to treatment modality. Surgical techniques were classified into five groups: simple closure technique in the midline, asymmetric or oblique closure techniques, and full-thickness flap techniques like rhomboid flaps, vy-plasty, and z-plasty. Estimations of the incidences resulted from the quotient of number of responses and the number of patients for each study, and these quotients were summarized over all studies.
The MEDLINE search identified 74 publications including 10,090 patients. Pooled data analysis revealed an inhomogeneous effect of the surgical techniques on the infection rate. In contrast, there was a significantly lower early failure rate and late recurrence rate of both the asymmetric-oblique closure techniques and the full-thickness flap techniques when compared with the midline repair technique. No difference was found between the asymmetric repairs and the full-thickness flap techniques.
Beside the various statistical considerations when using a pooled data analysis combining results from the literature, this overview suggests a significant benefit of asymmetric-oblique closure techniques or flap techniques in comparison with simple closure in the midline. Thus, we recommend an asymmetric closure technique for primary closure of a chronic pilonidal sinus. These asymmetric procedures provide better results than the simple closure in the natal midline. Furthermore, they are not as sophisticated as the full-thickness plasty techniques.
藏毛窦是一种常见疾病，手术切除并随后闭合伤口对于持久治愈至关重要。为了评估不同一期闭合技术的效果，我们对过去35年发表的数据进行了汇总分析。
我们确定了与治疗方式相关的伤口感染、早期失败和晚期复发情况的报告。手术技术分为五组：中线简单闭合技术、不对称或斜向闭合技术以及全厚皮瓣技术，如菱形皮瓣、V-Y成形术和Z成形术。发病率的估计值来自每项研究中反应数与患者数的商，并对所有研究中的这些商进行汇总。
MEDLINE检索确定了74篇出版物，包括10,090名患者。汇总数据分析显示手术技术对感染率的影响不均匀。相比之下，与中线修复技术相比，不对称斜向闭合技术和全厚皮瓣技术的早期失败率和晚期复发率均显著降低。不对称修复技术和全厚皮瓣技术之间未发现差异。
除了在使用汇总文献结果的数据分析时的各种统计考虑因素外，本综述表明与中线简单闭合相比，不对称斜向闭合技术或皮瓣技术有显著益处。因此，我们建议采用不对称闭合技术对慢性藏毛窦进行一期闭合。这些不对称手术比会阴中线的简单闭合效果更好。此外，它们不像全厚整形技术那样复杂。
