Lohsiriwat Varut
Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Prannok Road, Bangkok, 10700, Thailand.
Surg Today. 2009;39(3):189-93. doi: 10.1007/s00595-008-3846-z. Epub 2009 Mar 12.
This review discusses the incidence, pathogenesis, risk factors, diagnosis, and therapeutic options for persistent perineal sinus (PPS), defined as a perineal wound that remains unhealed more than 6 months after surgery. The incidence of PPS after surgery for inflammatory bowel disease (IBD) ranges from 3% to 70% and after abdominoperineal resection (APR) for low rectal cancer, it can be up to 30%. These unhealed wounds are frequently related to perioperative pelvic or perineal sepsis. Crohn's disease (CD) and neoadjuvant radiation therapy are also important risk factors. The management of PPS is based on an understanding of pathogenesis and clinical grounds. The advantages and disadvantages of the current therapeutic approaches, including the topical administration of various drugs, vacuum-assisted closure, and perineal reconstruction with a muscle flap or a myocutaneous flap are also discussed.
本综述讨论了持续性会阴窦道（PPS）的发病率、发病机制、危险因素、诊断及治疗选择。PPS定义为手术后6个月以上仍未愈合的会阴伤口。炎症性肠病（IBD）手术后PPS的发病率为3%至70%，低位直肠癌经腹会阴联合切除术（APR）后，其发病率可达30%。这些未愈合的伤口常与围手术期盆腔或会阴感染有关。克罗恩病（CD）和新辅助放疗也是重要的危险因素。PPS的治疗基于对发病机制的理解和临床依据。文中还讨论了当前治疗方法的优缺点，包括各种药物的局部应用、负压封闭引流以及采用肌瓣或肌皮瓣进行会阴重建。
