مقايسه نتايج درماني چهار روش جراحي سينوس پيلونيدال ساكروم با پيگيري درازمدت

Comparison of outcomes in four different surgical methods for sacral pilonidal sinus with long-term follows-up

زمينه و هدف: سينوس پيلونيدال ناحيه ساكروم در فراد جوان شايع است. علت بيماري نامشخص بوده و روش‌هاي جراحي آن مختلف مي‌باشد. در اين مطالعه نتايج درماني در چهار روش مختلف جراحي سينوس پيلونيدال با پيگيري طولاني‌مدت بررسي و مقايسه شدند. روش بررسي: اين مطالعه به‌صورت مقطعي از فروردين 1396 تا مهر 1396 در بخش جراحي بيمارستان بقيه‌الله (عج) تهران انجام شد. مطالعه بر روي 182 بيمار مبتلا به سينوس پيلونيدال پس از انجام عمل جراحي صورت گرفت. اين بيماران كه به روش‌هاي مختلف مانند (باز، بسته، نيمه بسته و محدود) تحت عمل جراحي قرار گرفتند. بيماران در فاصله زماني حداقل سه سال پس از پايان درمان، از نظر ميزان عود، رضايتمندي، مدت زمان ترميم و بهبود زخم و عوارض پس از درمان مورد پيگيري قرار گرفتند. يافته‌ها: تعداد 44 بيمار به شيوه عمل جراحي بسته، 48 بيمار به شيوه عمل جراحي باز، 48 بيمار نيمه بسته و 42 بيمار به روش اكسيزيون محدود عمل شدند. بيشترين ميزان عود در روش باز وجود داشت و در روش بسته هيچ مورد عود ديده نشد. در روش جراحي بسته ميزان خونريزي و پس از عمل كمتري داشتند، همچنين مدت زمان بهبودي سريع‌تر بود. ميانگين ميزان رضايتمندي پس از عمل جراحي در كل بيماران 8/7±88/9 به‌دست آمد كه در روش بسته 5/3±95/9 در مقايسه با ساير روش‌هاي جراحي از برتري بالاتري برخوردار بود (0/001P<). نتيجه‌گيري: نتايج اين مطالعه نشان داد كه در موارد معمولي و غيرپيچيده بيماري سينوس پيلونيدال ناحيه ساكروم، روش اكسيزيون كامل و بستن اوليه داراي عوارض كمتر و رضايتمندي بيشتري است.

Background: Sacrococcygeal pilonidal disease (PD) is prevalent in the young adults. The cause of PD is unclear, and there are different surgical procedures for the treatment. The Pilonidal sinus disease is an unpleasant, chronic relapsing condition that is difficult to cure. There is a wide variety of surgical treatments with sub-optimal results for it. The ideal treatment for the pilonidal sinus disease has yet to be defined. There are many surgical approaches described in the literature. In this study, the longterm outcomes of four current surgical methods for PD were evaluated and compared. We aimed to assess recurrence, satisfaction, complications rate and wound healing time in the four current surgical methods for PD. Methods: This cross-sectional study was conducted in the Department of Surgery at the Baqiyatallah University Hospital, Tehran, Iran, from April 2017 to September 2017. The study was carried out on 182 postoperative patients. Surgeries were performed in different methods such as; open, closed, semi-closed and limited excision. Diabetics, obese patients and patients with acute pilonidal abscess or prior PD surgery were excluded. All patients were followed for at least three years after surgery. During the follow -up period, patients were assessed for recurrence, satisfaction, complications rate and wound healing time. The outcomes were assessed by case notes analysis and follow-up telephone and postal questionnaires. Results: In this study forty-four patients were operated via closed Method, 48 patients through open, 48 via semi-closed and 42 one's trough limited excision methods. The highest rate of recurrence was in the open group. There were no cases of recurrence in the closed group. There were also less postoperative hemorrhage and faster wound healing in the closed group. The average satisfaction of all patients was 88.9±8.7. The mean satisfaction rate in the closed group was 95.9±5.3 which was higher than other groups. Conclusion: The results of this study demonstrated that in the non-recurrent cases of sacral pilonidal sinus, complete Excision and primary repair have fewer complications and shows higher satisfaction rate.