Pilonidal sinüslü hastalarda prognostik faktörler ve uygulanan tedavilerin morbiditeye etkileri ( Prospektif Klinik Çalışma )
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Tarih
2016
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info:eu-repo/semantics/openAccess
Özet
Genellikle genç eriskinlerde ortaya çıkan pilonidal sinüs hastalığı, mortal bir hastalık olmamasına rağmen, sık görülmesi, yasam kalitesini olumsuz etkilemesi ve sık nüks ederek isgücü kaybına sebebiyle morbiditesi yüksek olan önemli bir hastalıktır. Dicle Üniversitesi Tıp Fakültesi Genel Cerrahi Kliniğine, Subat 2008-Mart 2009 tarihleri arasında Pilonidal Sinüs hastalığı nedeniyle basvuran 112 hasta prospektif olarak incelendi. Her hasta için ayrı yarı takip formu olusturuldu. Çalısmada hastaların yas, cinsiyet, meslek, vücut kitle indeksi, ten rengi, aile öyküsü, sigara kullanımı, sistemik ve kongenital hastalıkarı ve önceden uygulanan tedavileri prospektif olarak sorgulandı. Hastalarımızın 5 `i (% 4,5) kadın, 107' si (% 95,5) erkek idi. Kadın oranının bu kadar düsük olmasının muhtemel nedeni ülkemizin sosyo-ekonomik kosullarından kaynaklı olabileceğidir. Yapılacak tedavide; cerrahi teknik, anestezi sekli (lokal ve spinal), dren uygulanması, sinüs sayısı, eksize edilen kavite çapı, patoloji sonucu, hastanede yatıs süresi,yara iyilesme süresi ve ise baslama süreci sorgulandı.Hastalar taburcu edildikten sonra, ilk bir haftalık sürede erken komplikasyon açısından değerlendirildi. Sonraki ilk bir 1 ay, 3 ay ve 6 ay süreler zarfında kontrollere çağrılarak takip edildi. Univariate analizde; erken komplikasyon ve nüks gelisimine etkili risk fakörlerinin karsılastırılması yapıldı. Buna göre; erken komplikasyon için, yara iyilesme süresi ve cerrahi teknik, nüks gelisimi açısından da, sinüs sayısı, eksize edilen kavite çapı, ise baslama süresi, sigara kullanımı, cerrahi teknik ve dren uygulamanın anlamlı olduğu görüldü. Logistik regresyon değerlendirmesine göre ise; erken komplikasyon için, cerrahi teknik, nüks gelisimi üzerine de, cerrahi teknik, sigara kullanımı ve eksize edilen kavite çapının istatistiksel olarak anlamlı olduğu saptandı (p<0.05). Sonuç olarak: Bu çalısma ile, Pilonidal sinüs hastalığının pre ve postoperatif hasta takibi ve sonucunda hastayı en iyi yasam konforuna kavusturacak tedavi seçeneğini sunma hedeflenmistir. Buna göre, Pilonidal sinüs hastalığında tedavinin cerrahi eksizyonla olması bir kez daha öne çıkmıstır. Cerrahi tekniklere bakıldığında; erken komplikasyonun primer onarımda, nüks gelisiminin ise diğer cerrahi yöntemlerde ( Limberg, Z-plasti, Karydakis ve flep kaydırma teknikleri ) az görüldüğü söylenebilir.
Pilonidal sinus generally occurs in young adults. It is not a cause of mortality but as it is seen widespread, progressing with relapses and decreasing the quality of life, it is an important disease with morbitidy. Patients (n=112) who were admitted to the clinic of General Surgery department of faculty of medicine of Dicle University with pilonidal sinus disease in between February 2008-March 2009 were enrolled in this study. A form was constituted for each patient. Baseline characteristics including age, sex, job, smoking consumption, family history, skin colour, body mass index, systemic and congenital diseases and former treatments were recorded prospectively for each subject. 5 of our patients were female ( % 4.5) and 107 were male ( % 95.5). The possible reason of rare females can be explained by social and economic situations. During the treatment procedure; surgery techniques, anesthesia situation (local and spinal), drain usage, number of sinuses, diameter of excision cavity, pathology results, the period of staying in hospital, the period of wound healing and the time of working were investigated. After leaving the hospital, the early complications in the first week were evaluated. At the 1., 3. and 6. months, the patients were controlled at the hospital for the disease situation. In univariate analyses, the risk factors that affects emerging of relaps and early complications were compared. Thus, for the early complications; the period of wound healing and surgery technique, for the emerging of relapses; the number of sinuses, diameter of excision cavity, the time of working, smoking consumption, surgery technique and drain usage were found to be significant. In logistic regression analyses; surgery technique for the early complications, for the emerging of relapses; surgery technique, smoking consumption and diameter of excision cavity found to be statistically significant (p<0.05). In this study we aimed to follow the patients before and after the operation and to apply the treatment that will give the best life comfort to them. The treatment of pilonidal sinus disease with excision is assessed to be the first choice. In surgical techniques; early complications in primary closure and progressing of relapses at the other techniques (Limberg, Z-plasty, Karydakis and the techniques of flep sliding) could determined to be rare
Pilonidal sinus generally occurs in young adults. It is not a cause of mortality but as it is seen widespread, progressing with relapses and decreasing the quality of life, it is an important disease with morbitidy. Patients (n=112) who were admitted to the clinic of General Surgery department of faculty of medicine of Dicle University with pilonidal sinus disease in between February 2008-March 2009 were enrolled in this study. A form was constituted for each patient. Baseline characteristics including age, sex, job, smoking consumption, family history, skin colour, body mass index, systemic and congenital diseases and former treatments were recorded prospectively for each subject. 5 of our patients were female ( % 4.5) and 107 were male ( % 95.5). The possible reason of rare females can be explained by social and economic situations. During the treatment procedure; surgery techniques, anesthesia situation (local and spinal), drain usage, number of sinuses, diameter of excision cavity, pathology results, the period of staying in hospital, the period of wound healing and the time of working were investigated. After leaving the hospital, the early complications in the first week were evaluated. At the 1., 3. and 6. months, the patients were controlled at the hospital for the disease situation. In univariate analyses, the risk factors that affects emerging of relaps and early complications were compared. Thus, for the early complications; the period of wound healing and surgery technique, for the emerging of relapses; the number of sinuses, diameter of excision cavity, the time of working, smoking consumption, surgery technique and drain usage were found to be significant. In logistic regression analyses; surgery technique for the early complications, for the emerging of relapses; surgery technique, smoking consumption and diameter of excision cavity found to be statistically significant (p<0.05). In this study we aimed to follow the patients before and after the operation and to apply the treatment that will give the best life comfort to them. The treatment of pilonidal sinus disease with excision is assessed to be the first choice. In surgical techniques; early complications in primary closure and progressing of relapses at the other techniques (Limberg, Z-plasty, Karydakis and the techniques of flep sliding) could determined to be rare
Açıklama
Anahtar Kelimeler
Pilonidal kist, Pilonidal cyst, Cerrahi, Surgery
