Guner Ali, Cekic Arif B, Boz Aydin, Turkyilmaz Serdar, Kucuktulu Uzer
Department of General Surgery, Karadeniz Technical University, College of Medicine, Farabi Hospital, 61080, Trabzon, Turkey.
Department of General Surgery, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey.
BMC Surg. 2016 Apr 16;16:18. doi: 10.1186/s12893-016-0134-5.
Although there are many therapeutic options to manage patients with sacrococcygeal pilonidal sinus disease, there remains controversy over a gold standard method for treating such patients. Most studies regarding sacrococcygeal pilonidal sinus, collected patients in a single pool, and single modality was performed to all patients so far. Staging according to the progressive nature of disease and comparisons of stage-based treatment approaches are yet to be conducted. This study aimed to define a staging system and to evaluate outcomes with the use of stage-based treatment approach.
The collected data of patients who underwent surgery for the treatment of pilonidal sinus disease prior to June 2011 were analyzed. Following this analysis, a staging system was defined based on morphological extent of disease (stage I to stage IV for primary disease, and stage R for recurrent disease). Specific surgical technique was used for each stage. Between June 2011 and December 2014, 367 patients were operated based on proposed staging system and treatment algorithm. Demographics, perioperative data, short-term and long-term outcomes were evaluated according to the disease stage.
For all patients, the median length of hospital stay was 1 (range, 0-4) day. Primary healing without any wound complications was achieved in 320 (87.2%) patients. The median time to functional recovery was 10 (range, 2-35) days and for wound healing was 12 (range, 10-55) days. Disease recurrence was identified in six (1.6%) patients within the median follow-up period of 29 (range, 5-47) months. The outcomes of each stage were evaluated separately.
We believe that the proposed staging system and stage-based treatment approach, which need further validation, will have an efficacy in the treatment of chronic pilonidal sinus disease and will contribute to the development of more appropriate individualized management approaches. Moreover, the use of this staging system will likely facilitate sharing and comparing more specific clinical data from future studies.
NCT02712970 (ClinicalTrials.gov/09.03.2016).
尽管有多种治疗骶尾部藏毛窦疾病患者的方法，但对于治疗此类患者的金标准方法仍存在争议。迄今为止，大多数关于骶尾部藏毛窦的研究将患者集中在一起，并对所有患者采用单一治疗方式。尚未根据疾病的进展性质进行分期以及比较基于分期的治疗方法。本研究旨在定义一个分期系统，并评估使用基于分期的治疗方法的效果。
对2011年6月之前接受手术治疗藏毛窦疾病的患者收集的数据进行分析。在此分析之后，根据疾病的形态学范围定义了一个分期系统（原发性疾病分为I期至IV期，复发性疾病为R期）。每个阶段使用特定的手术技术。在2011年6月至2014年12月期间，根据提议的分期系统和治疗算法对367例患者进行了手术。根据疾病分期评估人口统计学、围手术期数据、短期和长期结果。
所有患者的中位住院时间为1天（范围0 - 4天）。320例（87.2%）患者实现了一期愈合且无任何伤口并发症。功能恢复的中位时间为10天（范围2 - 35天），伤口愈合的中位时间为12天（范围10 - 55天）。在中位随访期29个月（范围5 - 47个月）内，6例（1.6%）患者出现疾病复发。分别评估了每个阶段的结果。
我们认为，提议的分期系统和基于分期的治疗方法虽需进一步验证，但将对慢性藏毛窦疾病的治疗有效，并有助于制定更合适的个体化管理方法。此外，使用该分期系统可能会促进未来研究中更具体临床数据的共享和比较。
NCT02712970（ClinicalTrials.gov/09.03.2016）
