Tejirian Talar, Lee Jenny J, Abbas Maher A
Department of Surgery, Section of Colon and Rectal Surgery, Kaiser Permanente, Los Angeles, California 90027, USA.
Am Surg. 2007 Oct;73(10):1075-8.
There is an ongoing debate regarding the optimal operation for chronic pilonidal disease. The current study analyzes the outcome of wide local excision (WLE) compared with unroofing and marsupialization (UM) as primary intervention for chronic pilonidal disease. A retrospective review of a single institution experience over a 5-year period was performed. Sixty-eight patients were treated for pilonidal disease. Their mean age was 25 years. There were 42 males (62%) and 26 females (38%). Twenty-six patients underwent WLE and 42 had UM. The type of operation was based on surgeon preference, but individual surgeons were consistent with their choice. Mean time for final healing was significantly higher for WLE compared with UM (21 vs. 6 weeks, P < 0.01). Postoperative complications and reoperative rate were significantly higher in the WLE group (P < 0.01). Nine patients in the WLE group (35%) required one or more reoperations compared with only one (2%) in the UM group (P < 0.01). This study demonstrates that WLE carries a high complication and reoperative rate. UM should be considered as the initial operation for most patients with pilonidal disease.
关于慢性藏毛窦疾病的最佳手术方式，目前仍存在争议。本研究分析了广泛局部切除（WLE）与切开引流和袋形缝合术（UM）作为慢性藏毛窦疾病主要干预措施的疗效。对一家机构5年期间的病例进行了回顾性研究。68例患者接受了藏毛窦疾病治疗。他们的平均年龄为25岁。其中男性42例（62%），女性26例（38%）。26例患者接受了WLE，42例接受了UM。手术方式基于外科医生的偏好，但每个外科医生的选择是一致的。与UM相比，WLE的最终愈合平均时间显著更长（21周对6周，P<0.01）。WLE组术后并发症和再次手术率显著更高（P<0.01）。WLE组有9例患者（35%）需要进行一次或多次再次手术，而UM组只有1例（2%）（P<0.01）。本研究表明，WLE的并发症和再次手术率很高。对于大多数藏毛窦疾病患者，应考虑将UM作为初始手术方式。
