Al-Khamis Ahmed, McCallum Iain, King Peter M, Bruce Julie
c/o Section of Population Health, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, UK, AB25 2ZD.
Cochrane Database Syst Rev. 2010 Jan 20;2010(1):CD006213. doi: 10.1002/14651858.CD006213.pub3.
Pilonidal sinus arises in the hair follicles in the buttock cleft. The estimated incidence is 26 per 100,000, people, affecting men twice as often as women. These chronic discharging wounds cause pain and impact upon quality of life. Surgical strategies centre on excision of the sinus tracts followed by primary closure and healing by primary intention or leaving the wound open to heal by secondary intention. There is uncertainty as to whether open or closed surgical management is more effective.
To determine the relative effects of open compared with closed surgical treatment for pilonidal sinus on the outcomes of time to healing, infection and recurrence rate.
For this first update we searched the Wounds Group Specialised Register (24/9/09); The Cochrane Central Register of Controlled Trials (CENTRAL) - The Cochrane Library Issue 3 2009; Ovid MEDLINE (1950 - September Week 3, 2009); Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations (September 24, 2009); Ovid EMBASE (1980 - 2009 Week 38); EBSCO CINAHL (1982 - September Week 3, 2009).
All randomised controlled trials (RCTs) comparing open with closed surgical treatment for pilonidal sinus. Exclusion criteria were: non-RCTs; children aged younger than 14 years and studies of pilonidal abscess.
Data extraction and risk of bias assessment were conducted independently by three review authors (AA/IM/JB). Mean differences were used for continuous outcomes and relative risks with 95% confidence intervals for dichotomous outcomes.
For this update, 8 additional trials were identified giving a total of 26 included studies (n=2530). 17 studies compared open wound healing with surgical closure. Healing times were faster after surgical closure compared with open healing. Surgical site infection (SSI) rates did not differ between treatments; recurrence rates were lower in open healing than with primary closure (RR 0.60, 95% CI 0.42 to 0.87). Six studies compared surgical midline with off-midline closure. Healing times were faster after off-midline closure (MD 5.4 days, 95% CI 2.3 to 8.5). SSI rates were higher after midline closure (RR 3.72, 95% CI 1.86 to 7.42) and recurrence rates were higher after midline closure (Peto OR 4.54, 95% CI 2.30 to 8.96).
AUTHORS' CONCLUSIONS: No clear benefit was shown for open healing over surgical closure. A clear benefit was shown in favour of off-midline rather than midline wound closure. When closure of pilonidal sinuses is the desired surgical option, off-midline closure should be the standard management.
藏毛窦起源于臀裂处的毛囊。估计发病率为每10万人中有26例，男性患病几率是女性的两倍。这些慢性流脓伤口会引发疼痛并影响生活质量。手术策略主要围绕切除窦道，然后进行一期缝合并实现一期愈合，或者让伤口敞开通过二期愈合。开放手术与闭合手术哪种管理方式更有效尚不确定。
确定藏毛窦开放手术与闭合手术治疗在愈合时间、感染及复发率方面的相对效果。
本次首次更新时，我们检索了伤口组专业注册库（2009年9月24日）；Cochrane对照试验中心注册库（CENTRAL）——Cochrane图书馆2009年第3期；Ovid MEDLINE（1950年至2009年第3周）；Ovid MEDLINE(R)在研及其他未索引引文（2009年9月24日）；Ovid EMBASE（1980年至2009年第38周）；EBSCO CINAHL（1982年至2009年第3周）。
所有比较藏毛窦开放手术与闭合手术治疗的随机对照试验（RCT）。排除标准为：非RCT；14岁以下儿童以及藏毛脓肿的研究。
由三位综述作者（AA/IM/JB）独立进行数据提取和偏倚风险评估。连续变量结果采用均值差，二分变量结果采用相对风险及95%置信区间。
本次更新又识别出8项试验，共纳入26项研究（n = 2530）。17项研究比较了开放伤口愈合与手术缝合。与开放愈合相比，手术缝合后的愈合时间更快。两种治疗方式的手术部位感染（SSI）率无差异；开放愈合的复发率低于一期缝合（RR 0.60，95% CI 0.42至0.87）。6项研究比较了中线手术与非中线缝合。非中线缝合后的愈合时间更快（MD 5.4天，95% CI 2.3至8.5）。中线缝合后的SSI率更高（RR 3.72，95% CI 1.86至7.42），中线缝合后的复发率也更高（Peto OR 4.54，95% CI 2.30至8.96）。
未显示开放愈合相对于手术缝合有明显益处。明确显示非中线伤口缝合优于中线缝合。当期望通过缝合治疗藏毛窦时，非中线缝合应作为标准治疗方法。
