Allen-Mersh T G
Westminster Hospital, London, UK.
Br J Surg. 1990 Feb;77(2):123-32. doi: 10.1002/bjs.1800770203.
Management of pilonidal sinus is frequently unsatisfactory. No method satisfies all requirements for the ideal treatment--quick healing, no hospital admission, minimal patient inconvenience, and low recurrence--but greater awareness of the strengths and weaknesses of existing methods would lead to improved management. Early excision of the pilonidal pit at the time of treatment of pilonidal abscess reduces the high (40 per cent) risk of subsequent sinus. Treatments for pilonidal sinus that flatten the natal cleft halve the risk of recurrence. En block excision of pilonidal sinus with secondary healing should be abandoned and emphasis given to development of treatments, such as primary asymmetric closure, which have more potential. Some treatments are operator-dependent and, to achieve the best results, junior surgeons must be correctly trained and supervised. Future treatment studies must be prospective and randomized, and should compare healing time, recurrence rates beyond 3 years, nurse and hospital visits, patient inconvenience and loss of income.
藏毛窦的治疗效果常常不尽人意。没有一种方法能满足理想治疗的所有要求——快速愈合、无需住院、对患者造成的不便最小以及复发率低——但如果能更清楚地了解现有方法的优缺点，将会改善治疗效果。在治疗藏毛窦脓肿时早期切除藏毛窦坑可降低随后形成窦道的高风险（40%）。使臀裂变平的藏毛窦治疗方法可将复发风险减半。应摒弃藏毛窦整块切除并二期愈合的方法，而应着重开发更具潜力的治疗方法，如一期不对称缝合。有些治疗方法依赖于操作者，为了取得最佳效果，初级外科医生必须接受正确的培训和监督。未来的治疗研究必须是前瞻性和随机的，并且应该比较愈合时间、3年以上的复发率、护士和医院的探访次数、患者的不便程度以及收入损失。
