菱形皮瓣转移治疗藏毛窦临床研究

doi:10.3877/cma.j.issn.2095-3224.2018.02.017

目的

评价菱形皮瓣转移术治疗骶尾部藏毛窦的临床疗效。

方法

回顾分析西安马应龙肛肠医院自2015年8月至2017年2月11例采用菱形皮瓣转移术治疗骶尾部藏毛窦的疗效。

结果

11例手术完成顺利，伤口裂开3例（27.27%），皮下血肿1例（9.09%），所有病例无切口感染，伤口痊愈中位时间21 d，术后随访1~18月无复发。

结论

菱形皮瓣转移术是治疗藏毛窦，尤其是复发性藏毛窦理想的手术选择。

关键词: 治疗, 菱形皮瓣, 藏毛窦, 手术

Objective

To evaluate the therapeutic effect of rhomboid flap graft for the pilonidal disease.

Methods

The clinical parameters were analyzed in the 11 patients who had undergone rhomboid flap graft for the pilonidal disease from August 2015 to February 2017, which were collected at the 1st Department of Anorectum, Xi′an Coloproctology Hospital.

Results

Operations were successful in all patients. In our research, there were 3 cases of wound dehiscence (27.27%), 1 case of hematoma (9.09%) and no wound infection. The median healing time is 21 days. 1 patient lost to follow-up, the others, follow-up time ranged from 1 to 18 months, without recurrence.

Conclusions

The rhomboid flap graft technique is a viable alternative for surgical management of pilonidal disease.

Key words: Therapy, Rhomboid flap, Pilonidal disease, Surgery

图6 创口缝合

图7 改良Limberg皮瓣转移切口设计

表1 患者术后临床资料

序号	术式^*	首次大便（d）	尾侧拔管（d）	头侧拔管（d）	下床时间（d）	间断拆线（d）	全部拆线（d）	术后住院（d）	愈合时间（d）	裂开?	张力性水泡	感染	血肿	复发
1	1	8	6	8	8	12	13	14	14	NO	NO	NO	NO	—
2	3	21	5	15	15	11	18	27	40	1	YES	NO	YES	NO
3	2	13	7	9	13	14	20	21	21	NO	NO	NO	NO	NO
4	2^**	15	9	10	15	—	—	21	21	NO	NO	NO	NO	NO
5	2^**	5	6	8	5	—	—	39	41	2	NO	NO	NO	NO
6	2	5	7	11	5	12	19	20	20	NO	NO	NO	NO	NO
7	2	12	5	8	10	13	15	16	16	NO	NO	NO	NO	NO
8	2	16	4	8	8	11	14	15	15	NO	YES	NO	NO	NO
9	2	14	9	11	8	11	16	17	17	NO	NO	NO	NO	NO
10	2	10	7	12	8	14	17	19	28	1	YES	NO	NO	NO
11	2	12	7	NO	10	10	14	14	14	NO	NO	NO	NO	NO
M	—	12	7	10	8	12	17	19	21	?	?	?	?	?

表1 患者术后临床资料

序号	术式^*	首次大便（d）	尾侧拔管（d）	头侧拔管（d）	下床时间（d）	间断拆线（d）	全部拆线（d）	术后住院（d）	愈合时间（d）	裂开?	张力性水泡	感染	血肿	复发
1	1	8	6	8	8	12	13	14	14	NO	NO	NO	NO	—
2	3	21	5	15	15	11	18	27	40	1	YES	NO	YES	NO
3	2	13	7	9	13	14	20	21	21	NO	NO	NO	NO	NO
4	2^**	15	9	10	15	—	—	21	21	NO	NO	NO	NO	NO
5	2^**	5	6	8	5	—	—	39	41	2	NO	NO	NO	NO
6	2	5	7	11	5	12	19	20	20	NO	NO	NO	NO	NO
7	2	12	5	8	10	13	15	16	16	NO	NO	NO	NO	NO
8	2	16	4	8	8	11	14	15	15	NO	YES	NO	NO	NO
9	2	14	9	11	8	11	16	17	17	NO	NO	NO	NO	NO
10	2	10	7	12	8	14	17	19	28	1	YES	NO	NO	NO
11	2	12	7	NO	10	10	14	14	14	NO	NO	NO	NO	NO
M	—	12	7	10	8	12	17	19	21	?	?	?	?	?

图11 间断缝合伤口复查（术后30 d）

[1]	McCallum IJ, King PM, Bruce J. Healing by primary closure versus open healing after surgery for pilonidal sinus: systematic review and meta-analysis [J]. BMJ, 2008, 336(7649): 868-871.
[2]	Farrell D, Murphy S. Negative pressure wound therapy for recurrent pilonidal disease: a review of the literature [J]. J Wound Ostomy Continence Nurs, 2011, 38(4): 373-378.
[3]	Søndenaa K, Nesvik I, Gullaksen F, et al. The role of cefoxitin prophylaxis in chronic pilonidal sinus treated with excision and primary suture [J]. J Am Coll Surg. 1995, 180(2): 157-160.
[4]	Isik A, Idiz O, Firat D. Novel Approaches in Pilonidal Sinus Treatment [J]. Prague Medical Report, 2016, 117(4): 145-152.
[5]	Harlak A, Mentes O, Kilic S, et al. Sacrococcygeal pilonidal disease: analysis of previously proposed risk factors [J]. Clinics, 2010, 65(2): 125-131.
[6]	Karydakis GE. New approach to the problem of pilonidal sinus [J]. Lancet, 1973, 2(7843): 1414-1415.
[7]	Karydakis GE. Easy and successful treatment of pilonidal sinus after explanation of its causative process [J]. Aust N Z J Surg, 1992, 62(5): 385-389.
[8]	Tokac M, Dumlu EG, Aydin MS et al. Comparison of modified Limberg flap and Karydakis flap operations in pilonidal sinus surgery: prospective randomized study [J]. Int Surg, 2015, 100(5): 870-877.
[9]	Horwood J, Hanratty D, Chandran P, et al. Primary closure or rhomboid excision and Limberg flap for the management of primary sacrococcygeal pilonidal disease? A meta-analysis of randomized controlled trials [J]. Color Dis, 2012, 14(2): 143-151.
[10]	Can MF, SevincMM, Hancerliogullari O, et al. Multicenter prospective randomized trial comparing modified Limberg flap transposition and Karydakis flap reconstruction in patients with sacrococcygeal pilonidal disease [J]. Am J Surg, 2010, 200(3): 318-327.
[11]	Bessa SS. Comparison of short-term results between the modified Karydakis flap and the modified Limberg flap in the management of pilonidal sinus disease: a randomized controlled study [J]. Dis Colon Rectum, 2013, 56(4): 491-498.
[12]	Limberg AA. Mathematical principles of local plastic procedures on the surface of the human body[M]. Medgis, Leningrad, 1946.
[13]	Limberg AA. The Planning of Local Plastic Operations on the Body Surface: Theory and Practice[M]. Translated into English by Wolfe SA, Collamore, Lexington, Massachusetts, USA, 1984, 576.
[14]	Green AR. Use of the rhomboid flap in pilonidal sinus [J]. Ann R Coll Surg Engl, 1986, 68(5): 293-294.
[15]	Chasmar LR. The versatile rhomboid (Limberg) flap [J]. Can J Plast Surg, 2007, 15(2): 67-71.
[16]	Allen-Mersh TG. Pilonidal sinus: finding the right track for treatment [J]. Br J Surg, 1990, 77(2): 123-132.
[17]	Horwood J, Hanratty D, Chandran P, et al. Primary closure or rhomboid excision and Limberg flap for the management of primary sacrococcygeal pilonidal disease A meta-analysis of randomized controlled trials [J]. Colorectal Dis, 2012, 14(2): 143-152.
[18]	Topgü K. Surgical treatment of sacrococcygeal pilonidal sinus with rhomboid flap [J]. J Eur Acad Dermatol Venereol, 2010, 24(1): 7-12.

[1]	孙佳丽, 金琳, 沈崔琴, 陈晴晴, 林艳萍, 李朝军, 徐栋. 机器人辅助超声引导下经皮穿刺的体外实验研究[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(09): 884-889.
[2]	史学兵, 谢迎东, 谢霓, 徐超丽, 杨斌, 孙帼. 声辐射力弹性成像对不可切除肝细胞癌门静脉癌栓患者放射治疗效果的评价[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(08): 778-784.
[3]	李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[4]	刘世君, 马杰, 师鲁静. 胃癌完整系膜切除术+标准D2根治术治疗进展期胃癌的近中期随访研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 27-30.
[5]	李华志, 曹广, 刘殿刚, 张雅静. 不同入路下行肝切除术治疗原发性肝细胞癌的临床对比[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 52-55.
[6]	常小伟, 蔡瑜, 赵志勇, 张伟. 高强度聚焦超声消融术联合肝动脉化疗栓塞术治疗原发性肝细胞癌的效果及安全性分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 56-59.
[7]	韩戟, 杨力, 陈玉. 腹部形态CT参数与完全腹腔镜全胃切除术术中失血量的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 88-91.
[8]	王露, 周丽君. 全腹腔镜下远端胃大部切除不同吻合方式对胃癌患者胃功能恢复、并发症发生率的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 92-95.
[9]	孙一娇, 包润发, 董平, 束翌俊. PBL结合手术视频剪辑教学在普通外科专科医师规范化培训中的应用与思考[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 96-99.
[10]	陈浩, 王萌. 胃印戒细胞癌的临床病理特征及治疗选择的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 108-111.
[11]	孙莲, 马红萍, 吴文英. 局部进展期甲状腺癌患者外科处理[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 112-114.
[12]	刘柏隆, 周祥福. 压力性尿失禁阶梯治疗的项目介绍[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(01): 125-125.
[13]	刘柏隆. 女性压力性尿失禁阶梯治疗之手术治疗方案选择[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(01): 126-126.
[14]	刘柏隆, 周祥福. 女性尿失禁吊带手术并发症处理的经验分享[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(01): 127-127.
[15]	张耕毓, 唐冲, 张昆, 张辉, 张清华, 刘家帮. 股骨头坏死髓芯减压术的文献计量学分析及单中心病例报道[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 771-780.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Clinical research of rhomboid flap graft for the pilonidal disease

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Clinical research of rhomboid flap graft for the pilonidal disease