儿童先天性臀部皮肤窦道的诊治  

Diagnoses and treatments of congenital buttock dermal sinus in children

作　　者：庞文博[1] 王凯[1] 张丹[1] 彭春辉[1] 王增萌[1] 吴东阳[1] 刘亚坤 黄心洁[1] 陈亚军[1] Pang Wenbo;Wang Kai;Zhang Dan;Peng Chunhui;Wang Zengmeng;Wu Dongyang;Liu Yakun;Huang Xinjie;Chen Yajun(Department of General Pediatric Surgery,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院普外科,北京100045

出　　处：《中华小儿外科杂志》2023年第5期434-438,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的总结儿童先天性臀部皮肤窦道的临床特点和诊治经验。方法收集2009年1月至2020年12月在首都医科大学附属北京儿童医院普外科行手术治疗先天性臀部皮肤窦道并规律随访的28例患儿的临床资料,其中男12例,女16例;首次发病年龄为(48.11±40.16)个月,范围在5~144个月,入院年龄为(77.50±49.55)个月,范围在14~185个月。手术采用沿瘘口周围切口,因窦道多止于骶前,为方便暴露,部分患儿采用臀部及骶尾部平行或阶梯状双切口。所有患儿做电话或门诊随访。结果男女比例为1∶1.33,其中男患儿占比42.9%(12/28),女患儿占比57.1%(16/28)。28例患儿均在生后发现先天性臀部皮肤凹陷,位于臀部两侧或肛门后方,其中3例患儿同时存在左/右臀部和肛门后方两处凹陷。患儿皮肤凹陷处多有反复感染,60.7%(17/28)患儿既往有手术史。术前MRI可显示窦道走行及骶前囊肿。病理结果均符合臀部窦道,92.9%(26/28)伴皮样囊肿或表皮样囊肿。28例患儿术前MRI及术中均未发现窦道与椎管相通。术后随访时间(43.04±36.55)个月(4~115个月),26例无并发症,另外2例复发,行二次手术,治愈。结论儿童先天性臀部皮肤窦道的显著标志是先天性臀部皮肤凹陷,凹陷处反复感染是其特征。窦道大部分走行于皮肤凹陷至骶前直肠后间隙,末端多有皮样囊肿或表皮样囊肿。手术完全切除窦道及囊肿是根治的方法。Objective To review our institutional experiences of managing congenital buttock dermal sinus.Methods From January 2009 to December 2020,28 children of congenital buttock dermal sinus were operated.There were 12 boys and 16 girls with a mean initial-onset age of(48.11±40.16)(5-144)months and a mean admission age of(77.50±49.55)(14-185)months.Double incision was selected for exploreing presacral lesion.Follow-ups were conducted by telephone or outpatient visits.Results The ratio of boy-to-girl was 1:1.33 with a boy proportion of 42.9%(12/28)and a girl proportion of 57.1%(16/28).All of them had congenital lateral buttock or postanal pit since birth and 3 children had a lateral buttock pit and a postanal pit at the same time.The infection of pits was common and 60.7%(17/28)of them were operated elsewhere.Magnetic resonance imaging(MRI)hinted at dermal sinus and presacral cyst.Dermoid or epidermoid cyst was detected in 92.9%(26/28)patients.Dermal sinus revealed no connection with spinal canal.The mean follow-up period was(43.04±36.55)(4-115)months.Except for two recurrent cases,the remainders were uneventful.Two cases were re-operated and had no recurrence ever since.Conclusions Congenital buttock dermal sinus is rare.A congenital lateral or postanal pit with recurrent infection is unique.Congenital dermal sinus always leads to presacral dermoid or epidermoid cyst.Complete resection of dermal sinus and cyst is the only curative option.

关 键 词：先天性畸形 臀 皮肤窦道 

分 类 号：R726.5[医药卫生—儿科]