骶尾部藏毛疾病診治中國專家共識（2023版）

最新：骶尾部藏毛疾病診治中國專家共識(2023版)摘要識(2023版)》,以提高我國SPD的診治水平。骶尾部藏毛疾病(sacrococcygealpilo20~40歲的青年男性，男女比例為2~4:1,歐美國家發(fā)病率為26/10萬分級具體描述證據(jù)強度分級高(A)中(B)低(C)極低(D)推薦強度分級強推薦弱推薦非常有把握觀察值效應值接近真實值效應值接近真實值效應值，但也有可能差別較大對觀察值效應值的把握有限：觀察值效應值可能與真實值有很大差別對觀察值效應值幾乎沒有把握：觀察值效應值與真實值效應值可能有極大差別明確顯示干預措施利大于弊或者弊大于利利弊不確定，或無論質量高低的證據(jù)均顯示利弊相當引起SPD的危險因素包括家族史、肥胖(體質指數(shù)>25k一項前瞻性研究將587例SPD患者與2780例健康人進行對照，結果發(fā)現(xiàn)，每天久坐>6h,每周洗澡<2次的多毛人群，患SPD的風險增加219(一)非手術治療A,推薦強度：強推薦)毛發(fā)，對SPD的治療有益[20-21]。剃毛的頻率建推薦意見4采用剃毛或激光脫毛去除臀溝及周圍皮膚的毛發(fā)可減少SPD成。治療可在門診局部麻醉下完成。文獻報道，石碳酸治療成功率為30%~92%,并發(fā)癥(感染或皮膚燒傷)的發(fā)生率<15%,有80%以上的患者的治愈率都為100%,但石碳酸治療組愈合速度更快、疼痛更輕及更早恢復正?；顒?，雖然復發(fā)率石碳酸治療組(18.6%)高于手術治療組(12.9%),但差異無統(tǒng)計學意義(P=0.92)[29]。然而，由于石碳酸的SPD。文獻報道，纖維蛋白膠的治療成功率為90%~100%[30-33]。囊腫一項對比用與不用纖維蛋白膠的Limberg皮瓣技術治療32例S間較短，傷口全部愈合，隨診8個月無復發(fā)病例[35]。然而，2017年的推薦意見6:靜脈應用抗生素的價值尚缺乏證據(jù)，可以視病(二)手術治療作的急性SPD行單純切開引流術后的治愈率為60%,部分患者需待局部15%~40%,可能與未處理中線小凹以及未徹底清除潛在的碎屑、毛發(fā)和實施膿腔搔刮組整體治愈率更高(96%比79%);術后65周內的復發(fā)率更低(10%比54%)[41]。一項Meta分析也強調，切開引流術的復發(fā)率低(4.5%),并發(fā)癥發(fā)生率僅為1.4%,且對急性和慢性SPD明顯低于皮瓣轉移術(12%比49%),1年后復發(fā)率更低[45]。其缺點是間為41~91d,而閉合切口的愈合時間為10~27d[44]。切除后袋形縫合的創(chuàng)面，縮短愈合時間[46];其復發(fā)率低(0~10%),愈合時間為3~4周，的復發(fā)率為1.5%,而一期縫合的復發(fā)率為17.0%,但比一期縫合愈合時對于一期縫合的患者(包括各種皮瓣技術),偏中線縫合優(yōu)于中線縫合，過去35年發(fā)表的數(shù)據(jù)(包括1萬例以上患者)進行Meta分析，結果顯示，偏中線縫合患者的術后感染率低于中線縫合術者(3.6%~9.3%比5年，總復發(fā)率為13.8%,二期(開放)愈合、中線縫合和偏中線一期縫合的復發(fā)率分別為17.9%、16.8%和10%,這使得偏中線縫合技術成為首(14.0~21.5d)和復發(fā)率低(0~5.4%)[53-55];缺點是皮瓣范圍較大，瓣底角位于臀溝(中線),容易發(fā)生底角裂開和延遲愈合。近年來，對該1992年使用該技術治療的6000例患者的資料結果顯示復發(fā)率<2%,抬高術治療69例特異性難治性SPD且傷口不愈合的患者后獲得了96%(三)微創(chuàng)技術小凹摘除、側方引流的方法治療50例SPD患者，術后1~2d即可恢復正常工作和生活，經過24個月的隨訪發(fā)現(xiàn)，平均愈合時間為3周，治愈范圍感染的患者，治愈率達100%,僅2例患者出現(xiàn)術后中線小凹處傷口效的前瞻性隨機研究，小凹摘除組隨訪36個月后的復發(fā)率達24%,明顯創(chuàng)、有效的技術。目前文獻報道，成功率在86%~94%[80-84]。激光使用功率通常為8~10W,波長為1470nm[82-83,85]。Yardimci[86]比傷口感染率更低(1.3%比7.2%),疼痛更輕，恢復工作時間更快(1.6d推薦意見11:可以使用激光消融、視頻輔助等微創(chuàng)技術治療SPD,但需(四)傷口管理現(xiàn)VAC治療的愈合時間更短(84d比93d),在2周的隨訪中，創(chuàng)面相急性[2]DaSilvaJH.Pilonidalcyst.causeandtreatment[J].DisColonRectum[3]HullTL,Wu1Pilonidaldisease[J].SurgClinNorthAm,[5]KhannaA,RombeauJL.Pilonidaldisease[J].ClinColonRectalSurg.2011,24([6]JohnsonEK,VogelJD,CowanML,etmanagementofpilonidaldisease[J].DisColonRectum,201[7]SteeleSR,HullTL,ReadTE,etal.TheASCRSDOL10.1007/978-3-319-25970-3.[8]YoussefAI.Thevalueofsuperficialpa2001,8(1):60-64.DOL10.1007/s10434-00caseandreviewoftheliterature[J].DisColonRectum,2007,50(9):1475-1477.DOL10.[11]BolandparvazS,MoghadamDPSalahiR,etal.Evaluationoftheriskfactorsofpilonidalsinus;:asinglecenterexperien[12]HarlakA,MentesO,KilicS,etal.SacrococcyPaulo),2010,65(2):125-131.DOL10.1590/51807-59322010000200002.[13]DollD,MatevossianE,WietelmannK,etal.Familyhistoryoflong-termrecurrencerate[J].DisColonRectum,2009,52(9):1610-1615.DOE10.1007/DCR.0b013[14]TezelE.Anewclassificationaccordingtonavicularareaconceptforsacrococcygealpilonidaldisease[J].ColorectalDis,2007,[15]GunerA,CekicAB,BozA,etal.Aproposedstagingsystemforchronicsymptomaticpilonidalsinusdiseaseandresutreatedwithstage-basedapproach[J].BMCSurgery,2016,16:18.DOI:10.1186/s12893-016-0134-5.[16]IrkorucuO.Managementforpilonidaldi[17]BealEM,LeeMJ,Hin2019,23(5):435-443.DOL10.[18]lesalnieksI,OmmerA,LangenbecksArchSurg,2021,406(8):2569-2580.DOl:10.1007/500423-020-02060-1.[19]DollD,FriederichsJ,BoulesteixAL,etal.Surgeryforasymptomaticpilonidalsinusdisease[J].IntJC839-844.DOL10.1007/s003[20]KelatiA,Lagrangeretrospectivecase-controlstudyU].JEurAcadDermatolVenereol,2018,32021,30(5);455-461.DOI:10.1159/000516903.[22]ArmstrongJH,BarciaPI.Pilonidalsinusdisease:the10.1001/archsurg.1994.0142033[23]Petersen5,WietelmannK,EversT,etal.Long-termeffectsofpostoperativerazoRectum,2009,52(1):131-134.DOL10.1007/DCR.0b013e3181972505.[24]PronkAA,EppinkL,SmakmanN,etal.Theeffectofhairremovalaftersurgeryfosystematicreviewoftheliterature[J].TechColoproctol,2018,22(1):[25]LukishJR,KindelanT,MarmonLM,etal.Laserepilationissafeandeffectivetherapyforteenagerswithpilonidaldisease[J].J[26]Dogru0,CamciC,Ayge2004,47(11):1934-1938.DOI10.1007/s10350-004-disease[J].DisColonRectum,2010,53(6):932-935.DOl:10randomizedtriallJ].DisColonRectum,2017,60(2):161[30]SeleemMI,Al-HashemyAM.Managem[31]ElbannaHG,EmileSH,YoussefM,etal.NovelapproachoftreatmentofpilonidalsinussealantJ].DisColonRectum,2016,59(8):775-780.DOL:10.1097/DCR.0000[32]SianTS,HerrodPIJ,BlackwellJEM,etal.Fibringlueisaquisinusdiseaseinchildren[J].JPediatrSurg,2019,54(8):1668-1[34]ElseyE,LundJN.FibringlueinthetreatmentforpilonidalsinuTechColoproctol,2013,17(1):101-104.DOE10.1007/s10151-012-0956-9.Coloproctol,2007,11(1):22-25.DOl:10.1007/[36]LundJ,TouS,DolemanB,etal.FibringlueforpilonidalsinusdiseaselJ].CochraneDatabaseSystRev,2017,1(1DOE10.1002/14651858.CD011923pub2.[37]ChaudhuriA,BekdashBA,Tsinuseswithprimaryclosureaprospective,randomized,doubDOE10.1007/s00384-005-0064-7.DOL10.1007/s00384-015-2425-1.[39]MavrosMN,Mitsikostliterature[J].EurJClinMicrobiolInSurg,2014,207(6):907-914.DOI:10.1016/jamjsurg.2013.07.038.abscess[J].SaudiMedJ,2005,26(4):553-555.[42]GargRMenonGR,GuptaV.Layingopen(deroofing)andcurettageofsinusastreatmenandmeta-analysis[J].ANZJSurg,2016,86:27-33.DOL10.1111/ans.13377.[43]HosseiniSV,BananzadehAM,RivazM,etal.Thecomparisonbetweendrainage,delayedexcisionandprimaryclosurewitandsecondaryhealinginmanagementofpilonidalabscess[J].In[45]KaserSA.Zengaffinenofapilonidalsinus:amulticentrerandomDOE10.1007/s00384-014-205[46]RuffoBE,AnorectalA.In:CormanML,ed.C[47]AydedeH,ErhanY,SakaryaA[48]ErsoyOF,Karaca5,KayaogluHA,eanalysisof175patients[J].KaohsiungJMed[49]GencosmanogluR,InceogluR.Modiftotalexcisionwithprimaryclosureinthetreatmentofchronicsacrococcygealpilonidalsinus:aprospectwithacompletetwo-yearfollow-up[J].IntJColorectalDis,2005,20(5);415-422.DOL10.1[50]MaghsudiH,AlmassurgicaltreatmentofpilonidalcystsUl.PlastSurgNurs,2020,40(2):81-85.D[51]Petersen5,KochR,StelznerS,etal.Primaryclosuretechniquesinchronicpilonidalsinus:asursurgicalapproachesU].DisColonRectum,2002,45(11):1458-1467.DOL10.1007/510350-004-64[52]MiloneM,VelottiN,MSurgeon,2018,16(5):315-320.DOL:10.1016/jsurge.2018.03.009.sacrococcygealpilonidaldisease?Ameta-analysisofrandomizedcontropilonidalsinus,intermsoffrequencyofpost-operatiDOL10.12669/pjms.341.13929.pilonidaldisease[J].AmJSurg,2010,200(1):9-14.DOL:10.1016/jamjsurg.[57]KayaB,ErisC,AtalayS,etal.ModifiedLimbergtranspositionf2012,16(1):55-59.DOI:10.1007/s10151-011-0799-9.28(1):69-71.DOL10.3760/cmajissn.1009-4598.2012.01.020.pilonidaldiseaseresultsof200militaryservicemembers[J].SurgToday,2009[62]KarydakisGE.Easyandsuccessfultreatmentofpilonidalsinusafterexplanationofitscausativeprocess[J[63]CalisirA,EceIComparisonoftheKeystoneflapandtheLimbergflaptechniqueinthesurgicaltreatdisease[J.UpdatesSurg,2021,73(6):2341-2346.DOL10.1007/s13[64]EmileSH,KhanSM,BarsomSH,etal.KarydakisprocedureversusLimbergflapfortreatmmeta-analysisofrandomizedcontrolledtrials[J]IntJColorectalDis[66]BascomJ,BascomT.Utilityo[67]GunerA,BozA,OzkanOF,etal.LimbergflapversusBascomceftlifttechniquesforsacrococcygealpilonidals[68]GunerA,OzkanOF,KeceC,ModificationoftheBascomcleftliftpro[70]FazeliMS,AdelMG,afterexcisionofthesacralpilonidalsinusres[71]NursalTZ,EzerA,CaliskanK,etal.Prospmethodsinpilonidaldisease[J]AmJSu50(9):1436-1444.DOL10.1007/s10350-007-0276-8.[73]BascomJ.Pilonidaldisease:originfromfollicleso567-572.DOE10.1016/s0022-3468(8[77]NordonIM,SenapatiA,CnppsNRAprospecticlosureforthetreatmentofchronicpilonidaldisease[J].AmJSurg,2009,197(2):189-192.DOL10.1016/jamjsurg.2008.01.020.[78]WilhelmA.Anewtechniqueforsphincter-preservinganalfistulareColoproctol,2011,15(4):445-449.DOL10.1007/s10151-011[79]DessilyM,ChararaF,Ralea[80]PappasAF,ChristodoulouDK.Anewminimallyinvasivetreatmentofpilonidalsinusdiseasewithtprospectivelargeseriesofpatients[J].Colorecta[81]Harju1,SoderlundF,YScandJSurg,2021,110(4):520-523.DOL10.1177/1457496920975610.[82]DessilyM,DziubeckM,ChahidiE,etal.TheSiLaCprocedurefDOE10.19668/jcnkiissn1674-0491.2021.06.01