gnckКолопроктологияKoloproktologia2073-75562686-7303Russian Association of Coloproctology10.33878/2073-7556-2023-22-2-149-159gnck-1780Research ArticleОБЗОРЫ ЛИТЕРАТУРЫ И МЕТААНАЛИЗLITERATURE REVIEWS AND METAANALYSISМалоинвазивные методы лечения хронического воспаления эпителиального копчикового хода (систематический обзор литературы и метаанализ)Minimally invasive treatment of pilonidal sinus disease (a systematic review and meta-analysis)https://orcid.org/0000-0003-1827-1872КозыреваС. Б.KozyrevaS. B.

Козырева Сабина Борисовна — аспирант кафедры колопроктологии; врач-колопроктолог отделения консультативной поликлиники

ул. Баррикадная, д. 2/1, стр. 1, г. Москва, 125993, Россия

Barrikadnaya st., 2/1, Moscow, 125993, Russia

sabina_96@list.ruhttps://orcid.org/0000-0002-1778-0571КостаревИ. В.KostarevI. V.

Костарев Иван Васильевич — д.м.н., заведующий отделения малоинвазивной проктологии и тазовой хирургии

ул. Баррикадная, д. 2/1, стр. 1, г. Москва, 125993, Россия

ул. Саляма Адиля, д. 2, г. Москва, 123423, Россия

Barrikadnaya st., 2/1, Moscow, 125993, Russia

Salyama Adilya st., 2, Moscow, 123423, Russia

https://orcid.org/0000-0002-1636-8075БлагодарныйЛ. А.BlagodarnyL. A.

Благодарный Леонид Алексеевич — профессор кафедры колопроктологии

ул. Баррикадная, д. 2/1, стр. 1, г. Москва, 125993, Россия

Barrikadnaya st., 2/1, Moscow, 125993, Russia

https://orcid.org/0000-0003-3649-1027ПоловинкинВ. В.PolovinkinV. V.

Половинкин В.В. — д.м.н., профессор

ул. 1 Мая, д. 167, корп. 1, г. Краснодар, 350086, Россия

1st May st., 167-1, Krasnodar, 350086, Russia

https://orcid.org/0000-0003-1701-142XЗахарянА. В.ZakharyanA. V.

Захарян Александр Виленович — аспирант, врач-колопроктолог отделения малоинвазивной проктологии и тазовой хирургии

ул. Саляма Адиля, д. 2, г. Москва, 123423, Россия

Salyama Adilya st., 2, Moscow, 123423, Russia

https://orcid.org/0000-0002-1636-8075ТитовА. Ю.TitovA. Yu.

Титов Александр Юрьевич — д.м.н., руководитель отдела общей и реконструктивной колопроктологии

ул. Саляма Адиля, д. 2, г. Москва, 123423, Россия

Salyama Adilya st., 2, Moscow, 123423, Russia

ФГБОУ ДПО РМАНПО Минздрава РоссииРоссияRussian Medical Academy of Continuous Professional EducationRussian FederationФГБОУ ДПО РМАНПО Минздрава России; ФГБУ «НМИЦ колопроктологии имени А.Н. Рыжих» Минздрава РоссииРоссияRussian Medical Academy of Continuous Professional Education; Ryzhikh National Medical Research Center of ColoproctologyRussian FederationГБУЗ «НИИ ККБ №1 им. проф. С.В. Очаповского МЗ КК»РоссияRegional Clinical Hospital No.3 named after S.V. OchapovskyRussian FederationФГБУ «НМИЦ колопроктологии имени А.Н. Рыжих» Минздрава РоссииРоссияRyzhikh National Medical Research Center of ColoproctologyRussian Federation202321062023222149159Copyright © Козырева С.Б., Костарев И.В., Благодарный Л.А., Половинкин В.В., Захарян А.В., Титов А.Ю., 20232023Козырева С.Б., Костарев И.В., Благодарный Л.А., Половинкин В.В., Захарян А.В., Титов А.Ю.Kozyreva S.B., Kostarev I.V., Blagodarny L.A., Polovinkin V.V., Zakharyan A.V., Titov A.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ruproctology.com/jour/article/view/1780ЦЕЛЬ

ЦЕЛЬ: провести систематический обзор литературы с целью обобщения информации, касающейся эффективности малоинвазивных методов лечения хронического воспаления эпителиального копчикового хода.

ПАЦИЕНТЫ И МЕТОДЫ

ПАЦИЕНТЫ И МЕТОДЫ: в систематический обзор включены результаты анализа 52 клинических исследований, отобранных из 2576 публикаций, найденных в базах данных. В рамках обзора приведены данные, касающиеся эффективности следующих методов: использования фибринового клея, синусэктомии, видеоассистируемого лечения ЭКХ, методов лазерной коагуляции и химической деструкции с использованием кристаллического фенола или его раствора. Относительно последних двух методов так же проведен метаанализ данных.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ: при сравнительной оценке результатов применения фенола и методик, сопровождающихся радикальным иссечением ЭКХ, наблюдалась статистически значимая разница в сторону большей частоты осложнений после иссечения ЭКХ (ОШ 0,42; 95% ДИ: 0,05–3,71), при этом частота рецидивов статистически значимо не различалась между методиками (ОШ 0,98; 95% ДИ: 0,45–2,16). При применении SiLaC вероятность рецидива заболевания была статистически значимо выше, чем после методов с иссечением ЭКХ (ОШ 4,02; 95% ДИ: 1,13–14,3, р = 0,03). Однако по частоте развития осложнений между SiLaC и радикальным иссечением ЭКХ статистической значимости выявлено не было (ОШ 0,63; 95% ДИ: 0,29–1,34).

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ: проведенный анализ данных литературы продемонстрировал высокую эффективность большинства малоинвазивных методов, которые наряду с радикальными вмешательствами вошли в спектр регулярного использования при лечении хронического воспаления ЭКХ. В качестве наиболее перспективных следует выделить методики химической деструкции и лазерной коагуляции ЭКХ.

AIM

AIM: to estimate the effectiveness of minimally invasive methods for treatment of chronic inflammation in pilonidal sinus disease by systematic review.

PATIENTS AND METHODS

PATIENTS AND METHODS: fifty-two clinical trials were selected from 2,576 papers in databases for systematic review. It included the following methods: the fibrin glue, the sinusectomy, the video-assisted pilonidal sinus treatment, the laser coagulation and the chemical destruction using crystallized phenol or its solution. Regarding the last two methods, a meta-analysis was carried out.

RESULTS

RESULTS: the meta-analysis demonstrated the high effectiveness of phenol and laser coagulation for pilonidal sinus disease. When comparing the results of phenol use and excisional techniques, there was a significant difference in higher frequency complications rate after excisional techniques (HR 0.42; 95% CI: 0.05–3.71), while the recurrence rate was the same (HR 0.98; 95% CI: 0.45–2.16). The probability of recurrence was significantly higher than after excision techniques in compare with SiLaC (HR 4.02; 95% CI: 1.13 14.3, p = 0.03). However, there was no significant differences in complication rate after SiLaC and excisional techniques (HR 0.63; 95% CI: 0.29–1.34).

CONCLUSION

CONCLUSION: the chemical destruction and laser coagulation are the most effective methods for pilonidal sinus treatment.

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