儿童骶尾部藏毛窦病的手术治疗：系统评价和荟萃分析。
Surgical interventions for the treatment of sacrococcygeal pilonidal sinus disease in children: A systematic review and meta-analysis.
机构信息
Department of General Surgery, Royal Derby Hospital, Derby, UK DE22 3NE; Department of Surgery, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, UK DE22 2DT.
Department of General Surgery, Royal Derby Hospital, Derby, UK DE22 3NE; Department of Surgery, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, UK DE22 2DT.
出版信息
J Pediatr Surg. 2019 Nov;54(11):2222-2233. doi: 10.1016/j.jpedsurg.2019.02.058. Epub 2019 Mar 16.
BACKGROUND
Pilonidal sinus disease (PNS) is not uncommon in children. Controversy remains over the best treatment and there is limited evidence. This systematic review and meta-analysis aims to establish which techniques have the best outcomes in children.
METHODS
MEDLINE, EMBASE and CENTRAL databases were searched. Studies reporting treatment outcomes for PNS in children were included.
RESULTS
Open healing has pooled risk of recurrence of 26% (95%CI 15-38%), risk of wound complication of 21% (9-36%) and wound healing ranged from 38-92 days. Midline primary closure has pooled risk of recurrence of 12% (8-18%), risk of wound complication of 30% (19-46%) and wound healing ranged from 8 to 32 days. Off-midline primary closure has pooled risk of recurrence of 6% (1-15%), risk of wound complication of 14% (6-25%) and wound healing was 27 days. VAC therapy has pooled risk of recurrence of 20% (0-65%) and wound healing ranged from 38 to 92 days. Minimally invasive techniques has pooled risk of recurrence of 7% (1-16%) and wound healing ranged from 21-30 days. Marsupialisation has pooled risk of recurrence of 6% (0-22%), and wound healing ranged from 6 to 41 days.
CONCLUSION
Evidence for management of PNS in children is poor. Off-midline primary closure, minimally invasive techniques, and marsupialisation have the best outcomes.
LEVEL OF EVIDENCE RATING
IV.
背景
藏毛窦疾病（PNS）在儿童中并不少见。对于最佳治疗方法仍存在争议，证据有限。本系统评价和荟萃分析旨在确定哪些技术在儿童中具有最佳疗效。
方法
检索 MEDLINE、EMBASE 和 CENTRAL 数据库。纳入了报道儿童 PNS 治疗结果的研究。
结果
开放式愈合的复发风险为 26%（95%CI 15-38%），伤口并发症风险为 21%（9-36%），伤口愈合时间为 38-92 天。中线一期缝合的复发风险为 12%（8-18%），伤口并发症风险为 30%（19-46%），伤口愈合时间为 8-32 天。非中线一期缝合的复发风险为 6%（1-15%），伤口并发症风险为 14%（6-25%），伤口愈合时间为 27 天。负压创面治疗的复发风险为 20%（0-65%），伤口愈合时间为 38-92 天。微创技术的复发风险为 7%（1-16%），伤口愈合时间为 21-30 天。袋形缝合的复发风险为 6%（0-22%），伤口愈合时间为 6-41 天。
结论
儿童藏毛窦疾病的治疗证据较差。非中线一期缝合、微创技术和袋形缝合术具有最佳的治疗效果。
证据质量评级
IV 级。
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