Enriquez-Navascues J M, Emparanza J I, Alkorta M, Placer C
Servicio de Cirugía General y Digestiva, Hospital Universitario Donostia, Universidad del Pais Vasco-Euskal Herria Unibersitatea, Pº Dr Beguiristain s/n, 20014, Donostia-San Sebastian, Spain,
Tech Coloproctol. 2014 Oct;18(10):863-72. doi: 10.1007/s10151-014-1149-5. Epub 2014 Apr 30.
There are different open healing and primary closure approaches for chronic pilonidal sinus (CPD) that differ in principles and extension.
To compare the results of different closure surgical techniques, we performed a meta-analysis of randomized controlled trials (RCT) comparing: (1) open wide excision versus open limited excision (sinusectomy) or unroofing (sinotomy); (2) midline closure (conventional and tension-free) versus off-midline; (3) advancing versus rotation flaps; and (4) sinusectomy/sinotomy versus primary closure.
Data extraction and risk of bias assessment were conducted independently by the authors using the Cochrane Collaboration's tool. Data were pooled using fixed and random-effects models. Primary outcomes were rate of healing, recurrence, wound infection and dehiscence. Twenty-five trials (2,949 patients) were included.
Four trials compared limited versus radical open healing. Although recurrence rate did not differ, all other outcomes favored the limited approach. Ten studies compared midline versus off-midline primary closure; wound infection and dehiscence were significantly higher after midline closure. Six RCT compared Karydakis/Bascom versus Limberg. No difference was found in recurrence or wound complications rate. Six RCT compared sinusectomy/sinotomy versus primary closure. Recurrence rate was significantly lower after sinusectomy/sinotomy; no significant differences were found in other outcomes.
Our meta-analysis suggest that some of the questions of which is the best surgical technique for CPD have now been answered: open radical excision and primary midline closure should be abandoned. Sinusotomy/sinectomy or en bloc resection with off midline primary closure are the preferred approaches.
对于慢性藏毛窦（CPD），有不同的开放愈合和一期缝合方法，其原理和范围有所不同。
为比较不同缝合手术技术的结果，我们对随机对照试验（RCT）进行了荟萃分析，比较：（1）广泛开放切除与有限开放切除（窦道切除术）或掀盖术（窦道切开术）；（2）中线缝合（传统和无张力）与非中线缝合；（3）推进皮瓣与旋转皮瓣；（4）窦道切除术/窦道切开术与一期缝合。
作者使用Cochrane协作网的工具独立进行数据提取和偏倚风险评估。数据采用固定效应模型和随机效应模型进行汇总。主要结局指标为愈合率、复发率、伤口感染率和裂开率。纳入了25项试验（2949例患者）。
四项试验比较了有限开放愈合与根治性开放愈合。虽然复发率没有差异，但所有其他结局均支持有限开放方法。十项研究比较了中线一期缝合与非中线一期缝合；中线缝合后伤口感染和裂开的发生率明显更高。六项RCT比较了卡里达基斯/巴斯科姆术式与林贝格术式。复发率或伤口并发症发生率没有差异。六项RCT比较了窦道切除术/窦道切开术与一期缝合。窦道切除术/窦道切开术后复发率明显更低；其他结局没有显著差异。
我们的荟萃分析表明，关于CPD最佳手术技术的一些问题现在已经有了答案：应摒弃根治性开放切除和中线一期缝合。窦道切开术/窦道切除术或整块切除加非中线一期缝合是首选方法。
