目的:我们介绍了通过活检穿孔切除术(BPE)治疗的848例藏毛毛发疾病(PD)患者的结果和复发情况,并将我们的结果与逐步获得的手术经验进行权衡。BPE是Bascom“选坑”过程和GIPS过程的修改后的“合并”版本。它使用不同口径的活检冲头,取决于治疗是在产后裂隙(口径尽可能小)还是侧切(较大口径穿孔或甚至小切口)。有时,此过程称为Bascom-Gips过程。
方法:总之,从2011年1月至2016年12月,连续848例PD患者接受治疗(性别:男性622例[73.4%],女性226例[26.6%];中位年龄26.2岁,平均年龄24.6±28.99[范围14-55]岁,男人25.1岁,女性24.8岁)。在这848名患者中,在2011-2012年运营了287个,在2013-2014年运营了301个,在2015-2016年运营了260个。在手术后12、24和60个月累积记录复发率,并通过单独检查三个双年期的结果(2011-2012年治疗年限或A组,2013-2014或B组,2015-2016年或C组)。
结果:平均手术时间为34±24.45分钟。术后并发症包括早期(<24h;n=22或2.6%)和延迟(>24h;n=26或3.1%)术后出血。83/848例患者(9.8%)发生术后积液(<2周),包括血肿(n=25)和血清肿(n=58)。平均21±12.72天后获得完全康复,平均4±12.02天后恢复工作/学校/大学活动。十二-,在725例(85.5%)中,有可能进行24个月和60个月的随访,848名患者中有682名(80.4%)和595名(70.2%)。总的显著差异(2=16.87,P=0.0002)在复发率:59复发/725患者(或8.1%)后1年,2年后89例复发/682例(或13.0%),5年后98例复发/595例(或16.4%)。然而,当将患者分为三个24个月子集时,在2011-2012年的三个双年度中,复发率呈稳定和渐进的下降(A组),2013-2014年(B组)和2015-2016年(C组),12-,48个月和60个月的随访。12个月后复发29/225(12.9%),A组的19/285(6.7%)和11/215(5.1%)(2=8.53,P=0.014),B和C;24个月后,36/226(15.9%),A组31/242(12.8%)和22/214(10.2%)(2=2.38,P=0.30N.S.),B和C;60个月后,38/194(19.5%),A组36/215(16.7%)和24/186(12.9%)(2=2.23,P=0.32),分别为B和C。
结论:BPE是一种有效的,以疾病为目标,微创和廉价的方法来治疗PD。其结果受相关团队经验的影响,特别是关于早期复发/手术失败。需要至少5年的随访以确定PD手术的结果。
We present the outcomes and the recurrences of 848 patients with pilonidal disease (PD) treated by biopsy punch excision (BPE) and we weigh our results against progressively obtained operative experience. BPE is a modified \'merged\' version of both the
Bascom \'pit picking\' procedure and the Gips procedure. It employs biopsy punches of different calibre, depending on whether treatment is in the natal cleft (calibre as small as possible) or lateral (larger calibre punches or even small incision). Sometimes this procedure is referred to as the
Bascom-Gips procedure.
In all, 848 consecutive patients with PD were treated from January 2011 until December 2016 (sex 622 [73.4%] men and 226 [26.6%] women; median age 26.2 years, mean age 24.6 ± 28.99 [range 14-55] years, men 25.1 years, women 24.8 years). Of these 848 patients, 287 were operated in 2011-2012, 301 in 2013-2014 and 260 in 2015-2016. The recurrence rates were recorded 12, 24 and 60 months after surgery both cumulatively and by examining the outcomes of the three biennia individually (years of treatment 2011-2012 or group A, 2013-2014 or group B, 2015-2016 or group C).
The mean operating time was 34 ± 24.45 min. Postoperative complications included early (<24 h; n = 22 or 2.6%) and delayed (>24 h; n = 26 or 3.1%) postoperative bleeding. Postoperative fluid collections (<2 weeks) occurred in 83/848 patients (9.8%) and included haematoma (n = 25) and seroma (n = 58). Full recovery was obtained after a mean of 21 ± 12.72 days and work/school/university activities were resumed after a mean of 4 ± 12.02 days. Twelve-, 24- and 60-month follow-ups were possible in 725 (85.5%), 682 (80.4%) and 595 (70.2%) patients out of 848. An overall significant (ꭓ2 = 16.87, P = 0.0002) difference was found in the recurrence rates: 59 recurrences/725 patients (or 8.1%) after 1 year, 89 recurrences/682 patients (or 13.0%) after 2 years and 98 recurrences/595 (or 16.4%) after 5 years. However, when subgrouping patients in three 24-month subsets, the recurrence rates showed a steady and progressive decrease in the three biennia 2011-2012 (group A), 2013-2014 (group B) and 2015-2016 (group C) at 12-, 48- and 60-month follow-ups. Recurrences after 12 months were 29/225 (12.9%), 19/285 (6.7%) and 11/215 (5.1%) (ꭓ2 = 8.53, P = 0.014) in groups A, B and C respectively; after 24 months, 36/226 (15.9%), 31/242 (12.8%) and 22/214 (10.2%) (ꭓ2 = 2.38, P = 0.30 N.S.) in groups A, B and C respectively; after 60 months, 38/194 (19.5%), 36/215 (16.7%) and 24/186 (12.9%) (ꭓ2 = 2.23, P = 0.32) in groups A, B and C respectively.
BPE is an effective, disease-targeted, minimally invasive and inexpensive way to treat PD. Its results are influenced by the experience of the team involved, especially regarding early recurrences/failure of surgery. At least 5-year follow-ups are needed to ascertain the outcome of surgery for PD.