背景:藏毛窦(PS)是一种获得性疾病,由反复感染和慢性炎症引起。涉及骶尾囊的PS被称为骶尾囊藏毛窦(SPS)。SPS是一种罕见的慢性传染病,手术是一个很好的选择。近年来,SPS的发病率在世界范围内逐渐增加。然而,外科医生尚未就SPS的首选手术方法达成共识。我们进行了系统评价和荟萃分析,以分析不同手术方式治疗SPS的疗效差异。
方法:在2003年1月1日至2023年2月28日的PubMed数据库中进行了系统搜索。主要结果参数为复发和感染。最后,使用RevMan5.4.1软件进行统计学分析(荟萃分析)。此外,系统回顾了近20年来SPS外科治疗的最新进展,尤其是过去3年的报道。
结果:27篇文章,54项研究,3,612名参与者被纳入本荟萃分析.中线闭合(MC)技术后的复发率远高于其他技术。在分析的技术中,MC和Limberg襟翼(LF)之间的差异,MC和有袋化(MA)之间有统计学意义(P=0.0002,RR=6.15,95%CI2.40,15.80;P=0.01,RR=12.70,95%CI1.70,95.06)。开放愈合(OH)的复发率高于Karydakis皮瓣(KF)技术,差异有统计学意义(P=0.02,RR=6.04,95%CI1.37,26.55)。将MC与其他技术进行比较的大多数结果表明,前者的感染率更高,MC和LF之间的差异有统计学意义(P=0.0005,RR=4.14,95%CI1.86,9.23)。KF和LF的比较,改良Limberg皮瓣(MLF)和KF显示在复发和感染方面差异无统计学意义(P≥0.05)。
结论:SPS有多种手术治疗方案,包括切口和引流,切除病变组织,进行初次闭合和二次愈合,和微创手术。尚无法确定哪种手术技术应被视为治疗的黄金标准,甚至不同研究人员使用相同操作方法的结果也是相互矛盾的。但可以肯定的是,中线闭合技术比其他技术术后复发和感染的发生率要高得多。因此,肛肠外科医师应在全面评估患者意愿的基础上,制定最适合患者的个体化方案,SPS的外观,和外科医生的专业能力。
BACKGROUND: A pilonidal sinus (PS) is an acquired disease resulting from recurrent infections and chronic inflammation. A PS involving the sacrococcyx is referred to as a sacrococcygeal PS (SPS). An SPS is a rare chronic infectious disease for which surgery is a good choice. The incidence of SPS has gradually increased worldwide in recent years. However, surgeons have not reached a consensus on the preferred surgical approach for SPS. The authors performed a systematic
review and meta-analysis to analyze differences in the efficacy of different surgical approaches for the treatment of SPS.
METHODS: A systematic search was conducted in the PubMed database covering the period from 1 January 2003, to 28 February 2023. The primary outcome parameters were recurrence and infection. Finally, statistical analysis (meta-analysis) was carried out using RevMan 5.4.1 software. In addition, we systematically reviewed the latest progress in the surgical treatment of SPS over the past 20 years, especially as reported in the past 3 years.
RESULTS: Twenty-seven articles, 54 studies, and 3612 participants were included in this meta-analysis. The recurrence rate following the midline closure (MC) technique was much higher than that of other techniques. Among the techniques analyzed, the differences between MC and Limberg flap (LF), and between MC and marsupialization were statistically significant [ P =0.0002, risk ratio (RR)=6.15, 95% CI 2.40, 15.80; P =0.01, RR=12.70, 95% CI 1.70, 95.06]. The recurrence rate of open healing was higher than that of the Karydakis flap (KF) technique, and the difference was statistically significant ( P =0.02, RR=6.04, 95% CI 1.37, 26.55). Most of the results comparing MC with other techniques suggested that the former had a higher infection rate, and the difference between MC and LF was statistically significant ( P =0.0005, RR=4.14, 95% CI 1.86, 9.23). Comparison between KF and LF, modified LF and KF showed that the differences were not statistically significant in terms of recurrence and infection ( P ≥0.05).
CONCLUSIONS: There are various surgical treatment options for SPS, including incision and drainage, excision of diseased tissue with primary closure and secondary healing, and minimally invasive surgery. It is still not possible to determine which surgical technique should be considered the gold standard for treatment, as even the results of different researchers using the same operation method are conflicting. But what is certain is that the midline closure technique has a much higher incidence of postoperative recurrence and infection than other techniques. Therefore, the anorectal surgeon should formulate the most suitable individualized plan for the patient based on a comprehensive evaluation of the patient\'s wishes, appearance of the SPS, and the professional ability of the surgeon.