Division of Pediatric Surgery, Department of Surgery, Stanford University, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA.
Pediatr Surg Int. 2024 Aug 14;40(1):224. doi: 10.1007/s00383-024-05818-6.
Severe pilonidal diseases have refractory symptoms despite multiple surgeries and optimal therapy remains unclear. We hypothesized that standardized minimally invasive protocol could be an effective rescue treatment.
We prospectively collected data from symptomatic patients who underwent ≥ 1 pilonidal excision prior to presentation at our clinic 2019-2023. We treated these patients with standardized protocol incorporating local wound care, regular manual/laser epilation, and selective debridement/pit trephination.
We treated 34 refractory patients (23 males) with median follow-up 405 days. Median age of first symptoms was 17.1 years; presentation to our clinic 20.0 years. Prior to our clinic, 27 received one surgery (cleft lift-2, excision no closure-1, excision primary closure-18, wound vac after excision-3, excision flap closure-3); 7 had two surgeries (excision without closure + cleft lift-1, primary closure after excision twice-3, flap closure after excision twice-2, excision primary closure + excision without closure-1). We treated all patients with regular epilation ± local wound care. 14 (41%) underwent trephination ± debridement. All patients achieved complete resolution after median 52 days. Five (14.7%) recurred and were treated with trephination + debridement-2 or wound care alone-3. Symptom length had no correlation with resolution time, skin type, hair amount.
Standardized minimally invasive protocol requiring only selective surgical intervention can treat refractory pilonidal disease with low recurrence rate.
尽管经过多次手术和最佳治疗，严重的藏毛疾病仍存在难治症状，其最佳治疗方法仍不明确。我们假设标准化微创方案可能是一种有效的挽救性治疗方法。
我们前瞻性地收集了 2019 年至 2023 年期间在我们诊所就诊的既往接受过≥1 次藏毛窦切除术但症状仍未缓解的患者的资料。我们采用标准化方案治疗这些患者，方案包括局部伤口护理、定期手动/激光拔毛和选择性清创/皮窦切开术。
我们治疗了 34 例难治性患者（23 名男性），中位随访时间为 405 天。首次出现症状的中位年龄为 17.1 岁；就诊于我们诊所的中位年龄为 20.0 岁。在来我们诊所之前，27 例患者接受过 1 次手术（切开引流术-2 例，切除一期缝合术-1 例，切除后负压吸引术-3 例，切除皮瓣转移术-3 例）；7 例患者接受过 2 次手术（切除一期缝合术+切开引流术-1 例，切除后二次缝合术-3 例，切除皮瓣转移术后二次缝合术-2 例，切除一期缝合术+切除后一期缝合术-1 例）。我们对所有患者均采用常规拔毛和局部伤口护理。14 例（41%）患者接受皮窦切开术和清创术。所有患者的中位缓解时间为 52 天，均完全缓解。5 例（14.7%）患者复发，其中 2 例接受皮窦切开术和清创术，3 例仅接受伤口护理。症状持续时间与缓解时间、皮肤类型、毛发量均无相关性。
仅需要选择性手术干预的标准化微创方案可以治疗难治性藏毛疾病，且复发率较低。
