Branagan G, Thompson M R, Senapati A
Department of Surgery, Queen Alexandra Hospital, Portsmouth, UK.
Colorectal Dis. 2006 May;8(4):314-7. doi: 10.1111/j.1463-1318.2005.00925.x.
Despite improvements in surgical practice, persistent perineal wound sinus is still a common complication after proctectomy. This study presents the success of a modified cleft closure technique in dealing with this problem.
From May 1997 patients with a persistent perineal sinus after surgery underwent a cleft closure - similar to that performed for patients with pilonidal sinus disease.
Eight patients (6 male, 2 female) with an average age of 52 years underwent a cleft closure for a persistent perineal sinus after surgery. Four patients had undergone a proctocolectomy (ulcerative colitis), 2 an abdominoperineal excision of the rectum (adenocarcinoma) and 2 a proctectomy (1 Crohn's disease, 1 complication of diverticular disease). Symptoms had been present for an average of 41 months (range 5-152 months) and 3 patients had undergone other procedures attempted previously to deal with the problem. The first three patients had the procedure as an inpatient with an average stay of 4.7 days. The next 5 patients had the procedure as a day case (2 local anaesthetic, 3 general anaesthetic). Two patients developed a postoperative wound infection and all but one wound had healed completely by 8 weeks. In this patient the procedure was repeated to achieve healing. There was no other associated morbidity and no postoperative deaths. There have been no recurrences to date.
Modified cleft closure for persistent perineal sinus is a simple procedure with low morbidity that can be performed under local anaesthetic in the day surgery unit.
尽管外科手术技术有所改进，但直肠切除术后会阴部伤口持续存在窦道仍是一种常见的并发症。本研究介绍了一种改良的裂隙闭合技术在处理这一问题上的成功经验。
自1997年5月起，对术后会阴部窦道持续存在的患者采用了类似于藏毛窦疾病患者所施行的裂隙闭合术。
8例患者（6例男性，2例女性），平均年龄52岁，因术后会阴部窦道持续存在接受了裂隙闭合术。4例患者曾接受全直肠结肠切除术（溃疡性结肠炎），2例接受经腹会阴直肠切除术（腺癌），2例接受直肠切除术（1例克罗恩病，1例憩室病并发症）。症状平均持续了4个月（5 - 152个月），3例患者此前曾尝试过其他方法来处理该问题。前3例患者住院接受手术，平均住院时间为4.7天。接下来的5例患者作为日间手术患者接受手术（2例局部麻醉，3例全身麻醉）。2例患者发生了术后伤口感染，除1例伤口外，其余所有伤口均在8周内完全愈合。对该例患者再次进行手术以实现愈合。无其他相关并发症，也无术后死亡病例。迄今为止无复发情况。
改良裂隙闭合术治疗持续性会阴部窦道是一种简单的手术，发病率低，可在日间手术单元在局部麻醉下进行。
