Esposito Ciro, Del Conte Fulvia, Cerulo Mariapina, Coppola Vincenzo, Esposito Giovanni, Ricciardi Elisabetta, Castagnetti Marco, Fabbrocini Gabriella, Escolino Maria
Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy.
Pediatric Surgery Unit, Medical University of Padua, Padua, Italy.
J Laparoendosc Adv Surg Tech A. 2020 Apr;30(4):464-470. doi: 10.1089/lap.2019.0614. Epub 2020 Feb 4.
Hidradenitis suppurativa (HS) is infrequent in the pediatric population. When indicated, surgery is often invasive, painful, and with significant recurrence rate. We aimed to report our preliminary experience using a new endoscopic technique to treat this pathology. We reported the data of 11 patients (9 girls and 2 boys) with average age of 15.7 years (range 14-17) with HS, who were operated using endoscopic procedure for a 15-month period. Six patients presented axillary, inguinal, and inframammary localizations, 3 patients presented axillary and inguinal localizations, and 2 patients presented only inguinal localization. Pediatric endoscopic hidradenitis treatment (PEHT) followed the same principles of pediatric endoscopic pilonidal sinus treatment (PEPSiT). The fistuloscope was introduced into the different holes, and after using an endobrush, all tracts were cauterized using monopolar electrode or laser energy, and finally the granulation tissues were removed using graspers. At the end of the procedure, all the holes were filled with oxygen-enriched oil-based gel and covered with fat gauze. The average operative time was 47 minutes (range 30-80). All procedures were performed in a day surgery setting or with an overnight hospitalization. All patients reported no pain postoperatively and performed a local dressing with silver sulfadiazine spray and oxygen-enriched oil-based gel two times per day for 1 month postoperatively. At the longest follow-up of 1 year, the lesions were completely healed in all cases. Two patients (18%) developed further lesions in different untreated localizations that were successfully treated using PEHT. PEHT is a minimally invasive, effective, and safe treatment option for pediatric patients with HS. All patients reported a painless postoperative period and excellent results. Postoperative local dressings using oxygen-enriched oil-based gel and silver sulfadiazine spray are fundamental to achieve the complete healing. However, a further evidence with larger series and longer follow-up is required to confirm these preliminary results.
化脓性汗腺炎（HS）在儿科人群中并不常见。如有必要进行手术，手术往往具有侵入性、疼痛且复发率高。我们旨在报告使用一种新的内镜技术治疗这种疾病的初步经验。我们报告了11例HS患者（9名女孩和2名男孩）的数据，平均年龄15.7岁（范围14 - 17岁），他们在15个月的时间里接受了内镜手术。6例患者的病变位于腋窝、腹股沟和乳房下，3例患者的病变位于腋窝和腹股沟，2例患者仅腹股沟有病变。小儿内镜下汗腺炎治疗（PEHT）遵循小儿内镜下藏毛窦治疗（PEPSiT）的相同原则。将瘘管镜插入不同的孔中，使用内镜刷后，用单极电极或激光能量烧灼所有窦道，最后用抓钳清除肉芽组织。手术结束时，所有的孔都用富氧油基凝胶填充，并用脂肪纱布覆盖。平均手术时间为47分钟（范围30 - 80分钟）。所有手术均在日间手术或过夜住院的情况下进行。所有患者术后均无疼痛，术后1个月每天用磺胺嘧啶银喷雾剂和富氧油基凝胶进行两次局部换药。在最长1年的随访中，所有病例的病变均完全愈合。2例患者（18%）在未治疗的不同部位出现了新的病变，使用PEHT成功治疗。PEHT是治疗小儿HS患者的一种微创、有效且安全的治疗选择。所有患者术后均无疼痛且效果良好。使用富氧油基凝胶和磺胺嘧啶银喷雾剂进行术后局部换药是实现完全愈合的关键。然而，需要更多病例系列和更长随访时间的进一步证据来证实这些初步结果。
