Surgery under general anaesthesia in severe hidradenitis suppurativa: a study of 363 primary operations in 113 patients
Surgery under general anaesthesia in severe hidradenitis suppurativa: a study of 363 primary operations in 113 patients
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DOI：
10.1111/jdv.12952
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发表时间：
2015-08-01
影响因子：
9.2
通讯作者：
Horvath, B.
中科院分区：
文献类型：
--
作者：
Blok, J. L.;Boersma, M.;Horvath, B.
背景化脓性汗腺炎（HS）的治疗是一项艰巨的任务，特别是对于首选手术技术尚未达成共识。我中心重度热射病（Hurley II/III）均在全身麻醉下进行手术，以STEEP手术为主。目的探讨全身麻醉下接受去顶手术或STEEP手术的热射病患者的特点、手术结果和患者满意度。方法对1999年至2013年期间接受全麻手术的所有患者进行基于临床记录的回顾性分析。患者满意度进行回顾性分析 结果研究期间共进行482例手术（363例初次手术，119例再次手术）。纳入人口中女性比例为68%。中位诊断延迟（患者和医生的延迟）为 6.5 年。 29.2% 的初次手术后出现复发。女性的复发率高于男性[比值比 2.85 (1.07;7.61)]。伤口肉芽增生是最常见的并发症，占所有手术的 7%。患者对手术医疗效果的中位评分为 8 分（满分 10 分）（0 分表示非常不满意，10 分表示非常满意）。结论 由于患者和医疗保健专业人员缺乏相关知识，HS 的诊断延迟时间较长，表明需要进行教育。 Deroofing 和 STEEP 是治疗严重 HS 病例的有效手术方法，患者满意度相对较高。女性术后复发风险较高。需要进行前瞻性研究来制定有关适当手术选择的明确指南。
BackgroundTreatment of hidradenitis suppurativa (HS) is a difficult undertaking, especially as there is no consensus on what surgical technique is preferred. At our centre severe HS (Hurley II/III) is operated under general anaesthesia, mostly with the STEEP procedure.ObjectivesTo investigate characteristics, surgical outcomes and patient satisfaction of HS patients who underwent deroofing or STEEP under general anaesthesia.MethodsA clinical records-based retrospective analysis was conducted of all patients who had surgery under general anaesthesia between 1999 and 2013. Patient satisfaction was retrospectively investigated with questionnaires.ResultsA total of 482 operations (363 primary operations and 119 re-operations) were performed during the study period. The proportion of women in the included population was 68%. The median diagnostic delay (patient's and doctor's delay) was 6.5years. Relapses occurred after 29.2% of primary operations. Women had higher relapse rates than men [odds ratio 2.85 (1.07;7.61)]. Hypergranulation of the wound was the most common complication and occurred in 7% of all operations. The median score patients attributed to the medical effect of surgery was eight of 10 (zero corresponding to very dissatisfied and 10 to very satisfied).ConclusionThe diagnostic delay in HS is long due to a lack of knowledge in both patients and health care professionals, indicating that there is a need for education. Deroofing and the STEEP are effective surgical procedures in severe cases of HS and lead to a relatively high patient satisfaction. The postoperative relapse risk is higher in women. Prospective studies are required for the development of clear guidelines on the appropriate choice of surgery.