asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/akh2025-014asurgery-553Research ArticleОБМЕН ОПЫТОМEXCHANGE OF EXPERIENCE | PRACTICEМесто первично-радикальной операции в лечении эпителиального копчикового хода в фазе острого воспаленияThe position of primary radical surgery for pilonidal cysts in the acute inflammatory phasehttps://orcid.org/0000-0002-9452-1979ГорИ. В.GorI. V.

Гор Иван Владимирович, к.м.н., врач-хирург, врач-колопроктолог, 

197110, Санкт-Петербург, пр. Крестовский, д. 18

Ivan V. Gor, Cand. Sci. (Med.), Surgeon, Coloproctologist,

18, Krestovskiy Ave., St Petersburg, 197110

ivan92gorr@gmail.comhttps://orcid.org/0000-0001-9112-0232ПоповД. Е.PopovD. E.

Попов Дмитрий Евгеньевич, к.м.н., главный внештатный специалист – колопроктолог Комитета по здравоохранению Санкт-Петербурга; доцент кафедры хирургических болезней стоматологического факультета с курсом колопроктологии, 197022, Санкт-Петербург, ул. Льва Толстого, д. 6–8;

заведующий колопроктологическим отделением № 3, 197110, Санкт-Петербург, пр. Крестовский, д. 18

Dmitry E. Popov, Cand. Sci. (Med.), Associate Professor, Chief Specialist – Proctologist of the Health Committee of St. Petersburg, Department of Surgical Diseases of Dental Faculty with a Course of Coloproctology, 6–8, Lev Tolstoy St., St Petersburg, 197022;

Неаd of Coloproctolology Department № 3, 18, Krestovskiy Ave., St Petersburg, 197110

dep.crc@gmail.comhttps://orcid.org/0000-0002-1039-4600СкуридинГ. М.SkuridinG. M.

Скуридин Гоча Михайлович, врач-колопроктолог,

197110, Санкт-Петербург, пр. Крестовский, д. 18

Gocha M. Skuridin, Coloproctologist,

18, Krestovskiy Ave., St Petersburg, 197110

senaki.72@mail.ruЯхъяевН. Р.YakhyaevN. R.

Яхъяев Нариман Русланович, врач-колопроктолог, 197110, Санкт-Петербург, пр. Крестовский, д. 18;

старший лаборант, 197022, Санкт-Петербург, ул. Льва Толстого, д. 6–8

Nariman R. Yakhyaev, Coloproctologist, 18, Krestovskiy Ave., St Petersburg, 197110;

Senior Lab Assistant, 6–8, Lev Tolstoy St., St Petersburg, 197022

Nariman.yakhyaev@mail.ruhttps://orcid.org/0000-0002-8415-4968ЗахаровА. Ю.ZakharovA. Yu.

Захаров Андрей Юльевич, врач-колопроктолог, заведующий отделением экстренной колопроктологии,

197110, Санкт-Петербург, пр. Крестовский, д. 18

Andrei Yu. Zakharov, Coloproctologist, Неаd of Urgent Coloproctolology Department,

18, Krestovskiy Ave., St Petersburg, 197110

b9@zdrav.spb.ruhttps://orcid.org/0009-0002-7828-2493ПахомовИ. А.PahomovI. A.

Иван Александрович Пахомов, врач-колопроктолог, руководитель центра лазерной хирургии,

190031, Санкт-Петербург, переулок Спасский, д. 14/35, литер А 

Ivan А. Pahomov, Coloproctologist, Head of the Laser Surgery Center,

letter A, 14/35, Spasskii Lane, St Petersburg, 190031

ivanpahomov1@yandex.ruГородская больница № 9, Городской центр колопроктологииРоссияSt Petersburg City Hospital No. 9, City Center of ProctologyRussian FederationПервый Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова; Городская больница № 9, Городской центр колопроктологии;РоссияPavlov First Saint Petersburg State Medical University; St Petersburg City Hospital No. 9, City Center of ProctologyRussian FederationГородская больница № 9, Городской центр колопроктологии; Первый Санкт-Петербургский государственный медицинский университет имени академика И.П. ПавловаРоссияSt Petersburg City Hospital No. 9, City Center of Proctology; Pavlov First Saint Petersburg State Medical UniversityRussian FederationКлиника GrandmedРоссияGrandmed СlinicRussian Federation202509062025221266270Copyright © Гор И.В., Попов Д.Е., Скуридин Г.М., Яхъяев Н.Р., Захаров А.Ю., Пахомов И.А., 20252025Гор И.В., Попов Д.Е., Скуридин Г.М., Яхъяев Н.Р., Захаров А.Ю., Пахомов И.А.Gor I.V., Popov D.E., Skuridin G.M., Yakhyaev N.R., Zakharov A.Y., Pahomov I.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.a-surgeon.ru/jour/article/view/553Введение

Введение. Вскрытие и дренирование гнойника является наиболее распространенным и рекомендуемым методом лечения нагноившегося эпителиального копчикового хода (ЭКХ). В литературе описано применение первично-радикальных методик, суть которых заключается в одномоментном экономном иссечении нагноившегося эпителиального хода с последующим открытым ведением раны, что приводит к ее полному заживлению вторичным натяжением. Рутинное использование первично-радикальных операций в экстренной колопроктологической практике ограничено недостаточным количеством работ, полноценно отражающих эффективность лечения ЭКХ в фазе острого воспаления.

Цель

Цель. Оценить эффективность использования первично-радикальных операций у пациентов с острым воспалением ЭКХ.

Материалы и методы

Материалы и методы. В ретроспективное исследование было включено 128 пациентов, которым в период с 2021 по 2024 г. на базе СПБ ГБУЗ «Городская больница № 9» было выполнено первично-радикальное хирургическое лечение ЭКХ в фазе острого воспаления. Основными критериями оценки эффективности первично-радикальных операций явились частота рецидивов, а также сроки формирования послеоперационного рубца.

Результаты

Результаты. Продолжительность оперативного вмешательства в среднем составила 8,4 мин (от 5 до 17 мин), интраоперационных осложнений зарегистрировано не было. Средние сроки госпитализации были менее 3 сут. У 5 пациентов (3,9%) на госпитальном этапе послеоперационный период осложнился кровотечением из послеоперационной раны, которое было остановлено в условиях перевязочного кабинета под местной анестезией. За среднее время наблюдения 9,4 мес. (от 6 до 42 мес.) безрецидивное заживление зарегистрировано у 125 (97,6%) пациентов. Продолжительность формирования послеоперационного рубца составила от 1,5 до 2,3 мес. (в среднем 1,7 мес.).

Обсуждение

Обсуждение. Вскрытие и дренирование гнойной полости при лечении острого воспаления ЭКХ переводит заболевание в хроническую форму, что часто требует второго этапа хирургического лечения после купирования явлений острой фазы воспаления. Одномоментное иссечение нагноившегося ЭКХ позволяет выполнить хирургическое лечение ЭКХ одним этапом, что дает повод рассмотреть возможности более широкого применения первично-радикальных операций.

Выводы

Выводы. Первично-радикальные операции могут быть безопасно применены у пациентов с острым воспалением ЭКХ.

Introduction

Introduction. Pilonidal abscesses are common surgical emergencies, typically managed through incision and drainage, requiring re-surgery after relief acute inflammation. The literature describes the use of primary-radical techniques, the essence of which lies in the one-stage economical excision of the suppurating epithelial tract with subsequent open management of the wound, which leads to its complete healing by secondary intention. Routine use of primary-radical operations in emergency proctological practice is limited by an insufficient number of studies that fully reflect the effectiveness of pilonidal disease treatment in the acute inflammatory phase.

Aim

Aim. To evaluate the effectiveness of using primary radical operations in patients with acute inflammation of the pilonidal disease.

Results

Results. The average duration of the surgical intervention was 8.4 minutes (5 to 17 minutes), no intraoperative complications were recorded. The average hospital stay was less than 3 days. In 5 patients (3.9%), the postoperative period was complicated by bleeding from the postoperative wound at the hospital stage, which was stopped in the dressing room under local anesthesia. During the average observation period of 9.4 months (from 6 to 42 months), recurrence-free healing was recorded in 125 (97.6%) patients. The duration of postoperative scar formation ranged from 1.5 to 2.3 months (on average 1.7 months).

Discussion

Discussion. Drainage the purulent cavity during treatment of acute inflammation of the pilonidal cyst transforms the disease into a chronic form, which often requires a second stage of surgical treatment after stopping the symptoms of the acute phase of inflammation. One-stage excision of the suppurating pilonidal cyst allows performing surgical treatment of the pilonidal disease in one stage, which gives reason to consider the possibilities of a wider use of primary-radical operations.

Conclusion

Conclusion. Primary radical surgeries can be safely used in patients with acute inflammation of the ECC.

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The authors declare that there are no conflicts of interest present.