Doll Dietrich, Krueger Colin M, Schrank Stefan, Dettmann Heidi, Petersen Sven, Duesel Wolfgang
Department of Surgery, Bundeswehrkrankenhaus Berlin, Berlin, Germany.
Dis Colon Rectum. 2007 Nov;50(11):1928-34. doi: 10.1007/s10350-007-9031-4.
This study was designed to evaluate the timeline of recurrence of pilonidal sinus disease after primary vs. multiple surgery. Data of medical military service in Germany were reviewed.
Telephone interview of 205 patients after pilonidal sinus disease surgery after median interval of 14.8 (standard deviation +/-3.9) years was conducted. A total of 345 patient charts with pilonidal sinus disease recurrence and fully documented previous surgery history were analyzed.
Pilonidal sinus disease recurred in 41 of 205 patients (20 percent; actuarial survival 22 percent) after first surgery. Median recurrence-free-interval was 1.8 (range, 0.1-16.5) years. Twenty-nine of 41 of all recurrences (71 percent) were observed within four years after primary surgery. Fifteen of 50 patients (30 percent) treated by primary closure had recurrent disease after a median recurrence-free interval of 2.7 (range, 0.2-13.5) years compared with 24 of 144 patients (17 percent), who experienced recurrence after rhomboid excision and open wound treatment after a median of 1.8 (range 0.1-16.5) years (P = 0.081, long-rank-test). Analysis of 345 recurrent disease charts revealed that recurrence time decreased for multiple recurrences compared with first recurrence (R1 vs. R2: P = 0.07; R2 vs. R3: P = 0.03, Mann-Whitney U test).
Long-term recurrence rate was 22 percent and thus higher than previously reported. This may be attributed to the long follow-up interval. Recurrences up to 20 years after surgery were seen. Our data provide evidence that follow-up after first to the third pilonidal sinus surgery should complete or exceed five years, because the majority of recurrences occur during this postoperative interval. Nevertheless, even a five-year follow-up will still miss 25 percent of recurrences.
本研究旨在评估初次手术与多次手术后藏毛窦疾病复发的时间线。回顾了德国义务兵役的数据。
对205例藏毛窦疾病手术后的患者进行电话随访，中位随访间隔为14.8（标准差±3.9）年。分析了345例有藏毛窦疾病复发且既往手术史记录完整的患者病历。
初次手术后，205例患者中有41例（20%；精算生存率22%）藏毛窦疾病复发。中位无复发生存期为1.8（范围0.1 - 16.5）年。所有复发患者中的41例中有29例（71%）在初次手术后4年内复发。50例接受一期缝合治疗的患者中有15例（30%）复发，中位无复发生存期为2.7（范围0.2 - 13.5）年，而144例接受菱形切除和开放伤口治疗的患者中有24例（17%）复发，中位无复发生存期为1.8（范围0.1 - 16.5）年（P = 0.081，长秩检验）。对345例复发病例的分析显示，与首次复发相比，多次复发的复发时间缩短（R1与R2：P = 0.07；R2与R3：P = 0.03，曼 - 惠特尼U检验）。
长期复发率为22%，因此高于先前报道。这可能归因于随访间隔时间长。术后20年仍可见复发。我们的数据表明，初次至第三次藏毛窦手术后的随访应完成或超过5年，因为大多数复发发生在这一术后时间段内。然而，即使进行5年随访仍会遗漏25%的复发病例。
