ObjectiveTo compare the clinical therapeutic efficacy of the pilonidal sinus with four kinds of surgical procedures. MethodsThe clinical data of 43 patients with sacrococcygeal pilonidal sinus treated from January 2008 to March 2013 were analyzed retrospectively. All of them were received surgery, in who 4 patients underwent pilonidal sinus resection alone(incision open group), 7 patients underwent incision and direct suturing after pilonidal sinus resection (incision and direct suturing group), 19 patients underwent marsupialization after pilonidal sinus resection(marsupialization group), and 13 patients underwent Limberg flap transposition after pilonidal sinus resection(rhombus flap transposition group). Results①There were not statistically significant differences regarding demographics among four groups (P > 0.05). 2 The hospital stay was(16.70±8.69) d, (16.43±10.68) d, (15.84±11.29) d, and(14.69±4.01) d in the incision open group, incision and direct suturing group, marsupialization group, and flap transposition group, respectively, and the healing time of incision was(64.75±6.50) d, (34.57±19.15) d, (35.16±15.49) d, and(17.92±4.29)d among the same four groups, respectively. The difference of the hospital stay was not statistically significant among four groups(P > 0.05). The healing time of incision in the flap transposition group was less than that in the other three groups(P < 0.05), which in the incision and direct suturing group and marsupialization group were shorter than those in the incision open group(P < 0.05), and which had no significant difference between the incision and direct suturing group and marsupialization group(P > 0.05).③The partial wound dehiscence occured in two patients and the wound was partially broken because of infection in two patients in the incision and direct suturing group. One patient was performed drainage because of emhysis and the wound tension blisters occurred in one patient in the flap transposition group. There was no complications in the other two groups. There was no recurrence after the wound healing of follow-up six months. ConclusionsAccording to this limited preliminary data, the selection of wound closure method depends on the incision tension. Direct suturing can be the choice for incision with lower tension. The marsupialization can be the choice for incision with higher tension. The Limberg flap transposition can be the choice for incision with extensive disease or postoperative recurrence.
Objective To summarize the methods of diagnosis and treatment for sacrococcygeal pilonidal sinus. Methods The processes of diagnosis and treatment for 84 patients with sacrococcygeal pilonidal sinus were analyzed retrospectively. The incision and primary suture with mattress-suture and exterminated dead space was performed in 36 patients （without recurrence and the length of fistulous tract was less than 5 cm）. The sinus resection and incision open surgery with excision of fully pathology tissue and regional treatment with Kangfuxin liquid was performed in 48 patients （with recurrence and the length of fistulous tract was more than 5cm）. Results Two cases were recurrent after half a year and cured with sinus resection and incision open surgery and regional treatment with Kangfuxin liquid in the incision and primary suture group. The others were disposable healing. The healing time in the incision and primary suture group was from 14 to 35d， the mean time was 26d， which in the other group was from 30 to 45d， the mean time was 37d. Follow-up for more than one year， none of recurrence happened. Conclusion Perfecting inspection before surgery， clarifying a diagnosis， choosing a suitable surgical treatment， and perioperative care could cure the disease and extremelyreduce recurrence.
Pilonidal sinus disease (PSD) is a suppurative inflammatory condition characterized by a sinus tract in the sacrococcygeal gluteal cleft and surrounding skin. Surgical resection is an important treatment for PSD; however, postoperative recurrence occurs in some patients, severely affecting their quality of life. Due to the lack of objective clinical indicators for predicting recurrence, developing an artificial intelligence-based prediction model is an effective approach. In this study, postoperative hematoxylin and eosin (H&E) stained pathological sections from PSD patients were used. The horizontal and vertical distance network (HoVer-Net) deep learning model for automated nuclei segmentation and classification was employed to extract nuclear features from lesion regions. These features were then integrated with multidimensional clinical characteristics to select key features. And then a machine learning classifier was incorporated to construct a recursive feature elimination-balanced random forest (RFE-BalancedRF) ensemble model to predict PSD recurrence. Experimental results demonstrate that the proposed PSD recurrence prediction model achieves an area under the curve of receiver operating characteristic (ROC_AUC) of 0.751 ± 0.048 and an accuracy (Acc) of 0.715 ± 0.066. Furthermore, a correlation exists between multimodal features and the risk of PSD recurrence, confirming the effectiveness of the proposed model in predicting PSD recurrence. This study innovatively integrates radiomics features with clinical characteristics from the dual perspectives of pathological image analysis and multimodal feature fusion to construct a PSD recurrence risk prediction model, potentially providing a new pathway with considerable clinical translation potential for artificial intelligence assisted medicine.