INTRODUCTION  介紹 — 

Pilonidal disease is a suppurative condition of the skin and soft tissue involving the sacrococcygeal cleft (sometimes referred to as the natal or gluteal cleft). It is an inflammatory condition that can be acute or chronically recurrent, and this condition may result in soft tissue infections, most often in the form of an abscess. Pilonidal disease is a common reason for seeking medical attention and can be a source of chronic debilitation due to symptoms of pain and drainage that diminish quality of life and interfere with activities of daily living. The clinical manifestations, diagnosis, and management of pilonidal disease are presented below.
藏毛病是皮膚和軟組織的化膿性疾病，涉及骶尾部裂（有時稱為出生間裂或臀間裂）。這是一種可以是急性或慢性復發的炎症性疾病，這種情況可能會導致軟組織感染，最常見的是膿腫。藏毛病是尋求醫療救助的常見原因，並且由於疼痛和引流癥狀會降低生活品質並干擾日常生活活動，因此可能是慢性衰弱的根源。藏毛病的臨床表現、診斷和治療見下文。

Pilonidal disease can be confused with other conditions, which are discussed in other topics (see 'Differential diagnosis' below):
藏毛病可能與其他疾病相混淆，詳見其他專題（參見下文 '鑒別診斷'）：

●(See "Cellulitis and skin abscess: Epidemiology, microbiology, clinical manifestations, and diagnosis".)
（參見 “蜂窩織炎和皮膚膿腫的流行病學、微生物學、臨床表現和診斷”）

●(See "Hidradenitis suppurativa: Pathogenesis, clinical features, and diagnosis".)
（參見 “化膿性汗腺炎的發病機制、臨床特徵和診斷”）

●(See "Perianal and perirectal abscess".)
（參見 “肛周和直腸周圍膿腫”）

ANATOMY  解剖學 — 

The sacrococcygeal, or natal, cleft is an intertrigonal groove extending from the sacrum to the cephalad aspect of the perianal region (figure 1). This cleft forms the border between the gluteus maximus muscles, which obscure the cleft when a person is upright (figure 2).
骶尾裂或胎舭裂是從骶骨延伸至肛周頭側的三角間溝 （ 圖 1）。該裂形成臀大肌之間的邊界，當人直立時，臀大肌會遮擋裂隙 （ 圖 2）。

While the natal cleft is the site of pilonidal disease, there are reports of skin manifestations similar to pilonidal disease in other locations such as the umbilicus, scalp, interdigital spaces, and folds surrounding the breasts [1-3]. Others have reported pilonidal sinus occurring in locations that would be subject to local trauma from hair, such as on the hands of barbers, sheep shearers, and dog groomers [4-6]. These infrequent presentations suggest that local skin trauma, including from hair, may play a role in the etiology of pilonidal disease. (See 'Etiology and pathogenesis' below.)
雖然出生裂是藏毛病的部位，但也有報導稱，臍部、頭皮、指間間隙和乳房周圍皺襞等其他部位也出現與藏毛病相似的皮膚表現[1-3]。其他人報告藏毛竇發生在毛髮局部創傷的部位，如理髮師、剪羊毛工和狗美容師的手[4-6]。這些罕見的表現表明，局部皮膚外傷（包括頭髮外傷）可能在藏毛病的病因中發揮作用。（參見下文 '病因和發病機制'）

Pilonidal disease is characterized by subdermal sinuses that are lined with granulation tissue, and that may communicate with subdermal potential spaces that may contain collections of hair and keratinous debris, in addition to granulation tissue [7-9]. Pilonidal cavities are not true cysts as they lack an epithelialized lining; these spaces serve as a nidus for abscess formation, and as a chronic source of discomfort, given that they come to be colonized by bacteria which leads to either chronic inflammation or an abscess (figure 3). Sinus tracts can extend in any direction from the natal cleft, and these can occasionally be mistaken for an anal fistula if they extend posteriorly toward the postanal space.
藏毛病的特徵是皮下竇內襯有肉芽組織，除肉芽組織外，還可能與皮下電位空間相通，皮下潛位空間可能含有毛髮和角質碎片的聚集[7-9]。藏毛腔不是真正的囊腫，因為它們缺乏上皮化襯裡;這些空間是膿腫形成的病灶，也是不適的慢性來源，因為它們會被細菌定植，從而導致慢性炎症或膿腫（ 圖 3）。鼻竇束可以從出生裂向任何方向延伸，如果它們向後延伸至肛后間隙，有時會被誤認為是肛瘺。

EPIDEMIOLOGY  流行病學 — 

The exact incidence of pilonidal disease is difficult to determine, given that the disease is not screened for and thus its discovery relies on a patient presenting with symptomatic disease. One study suggests that the incidence of pilonidal disease is 70,000 cases per year in the United States [10]; other series have estimated that the disease has a mean age of presentation of 19 years for females and 21 years for males, with males being affected two to four times more frequently than females [7,10,11]. Pilonidal disease is less frequent in children and in adults older than 45 years. Patient presentations are equally divided between acute and chronic disease, with few presenting with asymptomatic disease [12].
藏毛病的確切發病率很難確定，因為該疾病沒有經過篩查，因此其發現依賴於出現有癥狀疾病的患者。一項研究表明，美國藏毛病的發病率為 70,000 例/年[10];其他系列估計，該病女性的平均發病年齡為 19 歲，男性為 21 歲，男性發病率是女性的 2-4 倍[7,10,11]。藏毛病在兒童和 45 歲以上的成人中較少見。急性和慢性患者表現均等，少數患者表現為無癥狀[12]。

RISK FACTORS  風險因素 — 

Risk factors for pilonidal disease include [7,10,13]:
藏毛菌病的危險因素包括[7,10,13]：

●Overweight/obesity  超重/肥胖

●Local trauma or irritation
局部外傷或刺激

●Sedentary lifestyle or prolonged sitting
久坐不動或久坐

●Deep natal cleft  深產齶裂

●Hirsute natal cleft  多毛出生裂

●Family history  家族史

●Stiffer hair follicles [14]
毛囊變硬 [14]

●Polycystic ovary syndrome [15]
多囊卵巢綜合征[15]

Although these are typical risk factors, patients with none of these risk factors may still present with pilonidal disease.
儘管這些是典型的危險因素，但沒有這些危險因素的患者仍可能出現藏毛病。

ETIOLOGY AND PATHOGENESIS
病因和發病機制 — 

There has been controversy as to whether pilonidal disease is an acquired or congenital condition.
關於藏毛病是獲得性疾病還是先天性疾病一直存在爭議。

●The more accepted hypothesis is that pilonidal disease is acquired due to higher skin temperatures, moisture from sweat, and local trauma to hirsute skin in the natal cleft [8,16]. The convergence of these conditions can potentially create inflammation leading to the development of subdermal nests and tracts of granulation tissue akin to a foreign body reaction. Negative pressure caused by sitting and walking exerted on damaged hair follicles can also draw hair deep into the skin. This theory is supported by recurrent pilonidal disease despite extensive surgical resection of natal cleft tissue, and by the occurrence of skin inflammation in locations other than the natal cleft where local trauma due to hair is encountered. (See 'Anatomy' above.)
更廣為接受的假設是，藏毛病是由於皮膚溫度升高、汗液水分以及出生裂多毛皮膚局部創傷而獲得的[8,16]。這些條件的融合可能會產生炎症，導致皮下巢和肉芽組織束的形成，類似於異物反應。坐著和走路對受損毛囊造成的負壓也會將頭髮拉入皮膚深處。儘管對出生體裂組織進行了廣泛的手術切除，但復發性藏毛病以及在出生體裂以外的部位發生皮膚炎症，導致毛髮引起的局部創傷，這一理論得到了支援。（參見上文 '解剖學'）

●Others have argued that a congenital malunion of the midline sacrococcygeum is the cause of pilonidal disease. Within this paradigm, the treatment would involve surgical intervention to remove abnormal embryological remnants represented by subdermal nests of granulation tissue. Some studies reported that pilonidal disease can occur among multiple members of the same family, which raised the possibility of a genetic basis for pilonidal disease [17,18].
其他人則認為，中線骶尾骨先天性畸形癒合是藏毛病的原因。在這種範式中，治療將涉及手術干預，以去除以肉芽組織皮下巢為代表的異常胚胎殘餘物。一些研究報導稱，藏毛病可發生於同一家族的多個成員中，這增加了藏毛病遺傳基礎的可能性[17,18]。

CLINICAL MANIFESTATIONS  臨床表現

Patient presentation — Patient presentation is highly variable, ranging from an asymptomatic examination finding of a pilonidal pit or sinus, to the presence of the same but accompanied by discomfort and drainage, to a chronic, granulation-tissue bearing wound occupying the midline natal cleft [7,12]:
患者表現  —  患者表現差異很大，從無癥狀檢查發現藏毛窩或鼻竇，到存在相同但伴有不適和引流，再到慢性肉芽組織傷口佔據出生中線裂[7,12]：

Acute — Symptoms of an acute exacerbation include sudden onset of natal cleft discomfort. This discomfort can occur while sitting, and it is frequently exacerbated by performing a wide number of activities that stretch the skin of the natal cleft. Complaints can also include soft tissue induration, as well as a discharge that is most frequently serosanguinous or purulent. Fever and malaise are generally associated with either a soft tissue infection such as cellulitis or an undrained abscess.
急性  —  急性加重的癥狀包括突然發作的出生唇裂不適。這種不適可能會在坐著時發生，並且經常會因進行大量拉伸出生裂皮膚的活動而加劇。主訴還可能包括軟組織硬結，以及最常見的漿液性或膿性分泌物。發燒和不適通常與軟組織感染（如蜂窩織炎）或未引流的膿腫有關。

Chronic — Patients with chronic pilonidal disease experience recurrent or persistent drainage and/or pain. They may identify one or more areas of drainage (sinus tracts). Components of published classification schemes include the number, size, and location of pits/sinuses, tracks, and lesions, presence/absence of abscess, primary versus recurrent disease, and patient characteristics (sex, weight, hirsutum) [19]. Although some of these factors may influence the choice of surgical approaches, none of these schemes has been widely adopted for clinical use. (See 'Chronic disease' below.)
慢性  —  慢性藏毛病患者會出現反覆或持續的引流和/或疼痛。他們可能會識別一個或多個引流區域（鼻竇道）。已發表的分類方案包括凹坑/鼻竇、軌跡和病變的數量、大小和位置、有無膿腫、原發性疾病與復發性疾病以及患者特徵（性別、體重、多毛）[19]。儘管其中一些因素可能會影響手術方法的選擇，但這些方案都沒有被廣泛採用用於臨床。（參見下文 '慢性疾病'）

There have been occasional case reports of squamous cell carcinomas arising in long-standing, neglected pilonidal sinuses [20,21]. While this is exceedingly rare, the treating clinician should remember that chronic inflammation from any cause is a risk factor for malignant transformation. Patients presenting with any unusual skin finding should undergo a biopsy to exclude the rare development of squamous cancer.
偶有鱗狀細胞癌發生於長期被忽視的藏毛竇的病例報導[20,21]。雖然這種情況極為罕見，但治療臨床醫生應記住，任何原因引起的慢性炎症都是惡變的危險因素。出現任何異常皮膚發現的患者應進行活檢，以排除罕見的鱗狀癌發展。

Physical examination — Pilonidal disease is identified by exposing the natal cleft, allowing visualization of midline natal cleft sinuses, and, possibly, larger midline skin defects that contain granulation tissue.
體格檢查  —  藏毛病的識別方法是暴露產脈裂，可觀察中線產泥竇裂，並可能發現含有肉芽組織的較大中線皮膚缺損。

●For asymptomatic patients, the physical examination reveals one or more primary pits in the midline of the natal cleft. Less commonly, a painless sinus opening may be noted, though this is usually associated with some degree of drainage (figure 1).
對於無癥狀患者，體格檢查顯示出生裂中線有一個或多個原發性凹坑。不太常見的是，可能會發現無痛性鼻竇開口，但這通常與一定程度的引流有關 （ 圖 1）。

●For patients with acute-onset complaints, the examination often reveals cellulitis in the natal cleft, consistent with inflammation and a possible infection. If an abscess is present, a tender, indurated, or fluctuant region will also be observed.
對於急性發作的患者，檢查通常會發現出生裂有蜂窩織炎，與炎症和可能的感染一致。如果存在膿腫，還將觀察到壓痛、硬化或波動區域。

●For patients with chronic complaints, one or more sinuses will typically be present. Drainage is a frequent and recurrent complaint, most often with a purulent or serosanguinous character (picture 1). Hair may be observed protruding from a sinus opening [7,12].
對於患有慢性主訴的患者，通常會出現一個或多個鼻竇。引流是一種常見且反覆發作的主訴，最常見的是化膿性或漿液性血狀 （ 圖片 1）。可觀察到毛髮從鼻竇開口突出[7,12]。

DIAGNOSIS  診斷 — 

Asymptomatic pilonidal disease is diagnosed clinically based on findings of characteristic midline natal cleft pits. Acute and chronic symptomatic disease is established by visualizing midline pits accompanied by additional findings, such as an infection (ie, erythema, induration, fluctuance) or chronic drainage associated with one or more sinus openings. Imaging or laboratory studies are generally not necessary.
無癥狀藏毛病是根據特徵性中線出生齶裂凹坑的發現進行臨床診斷的。急性和慢性癥狀性疾病是通過觀察中線凹坑並伴有其他發現來確定的，例如感染（即紅斑、硬結、波動）或與一個或多個鼻竇開口相關的慢性引流。通常不需要影像學或實驗室檢查。

DIFFERENTIAL DIAGNOSIS  鑒別診斷 — 

Differentiating pilonidal disease from an alternative or concurrent disease requires a thorough examination and an understanding of natal cleft and anorectal anatomy.
區分藏毛病與替代或併發疾病需要徹底檢查並瞭解出生裂和肛門直腸解剖結構。

●Perianal abscess – A perianal abscess often presents with severe pain in the perianal region, and constitutional symptoms such as fever and malaise are common (picture 2). Physical examination reveals the site of infection within the 5 cm circumference surrounding the anal orifice, a region known as the anal margin. Pilonidal-related infections, including abscesses, will not involve the anal margin. Pilonidal abscesses are always located in the natal cleft area (figure 1). (See "Perianal and perirectal abscess", section on 'Clinical manifestations'.)
肛周膿腫 –肛周膿腫常表現為肛周劇烈疼痛，常見全身癥狀，如發熱和不適 （ 圖片 2）。體格檢查顯示感染部位位於肛口周圍 5 釐米周長內，該區域稱為肛門邊緣。藏毛相關感染，包括膿腫，不會累及肛緣。藏毛膿腫始終位於出生裂區域 （ 圖 1）。（參見 “肛周和直腸周圍膿腫”，關於'臨床表現'一節 ）

●Anal fistula – An anal fistula is the chronic manifestation of a cryptoglandular abscess. The diagnosis of an anal fistula is established on physical examination, revealing a fistula orifice within the anal margin, with associated symptoms that can include discomfort and drainage that can vary between serosanguinous and purulent. Manifestations of pilonidal disease will not involve the anal margin (picture 3). (See "Anorectal fistula: Clinical manifestations and diagnosis", section on 'Clinical features'.)
肛瘺 – 肛瘺是隱腺膿腫的慢性表現。肛瘺的診斷是通過體格檢查確定的，顯示肛門邊緣內有瘺管口，相關癥狀可能包括漿膜血腫和化膿性之間的不適和引流。藏毛病的表現不會累及肛緣 （ 圖片 3）。（參見 “肛門直腸瘺的臨床表現和診斷”，關於'臨床特徵'一節 ）

●Perianal Crohn disease – Perianal Crohn disease includes abscesses and fistulas, though the pathogenesis of these abscesses and fistulas differs from the more common cryptoglandular variety (picture 4). Symptoms attributable to perianal disease are virtually identical to abscesses and fistulas unrelated to inflammatory bowel disease, though, in Crohn patients, these perianal signs and symptoms can be accompanied by other complaints related to inflammation of the rectum, the colon, and the small bowel. Perianal Crohn disease, as the name implies, involves the perianal region rather than the natal cleft area. (See "Perianal Crohn disease".)
肛周克羅恩病 –肛周克羅恩病包括膿腫和瘺管，但這些膿腫和瘺管的發病機制與更常見的隱腺病不同 （ 圖片 4）。可歸因於肛周疾病的癥狀與與炎症性腸病無關的膿腫和瘺管幾乎相同，但在克羅恩病患者中，這些肛周體征和癥狀可能伴有與直腸、結腸和小腸炎症相關的其他主訴。肛周克羅恩病，顧名思義，涉及肛周區域而不是出生裂區域。（參見 “肛周克羅恩病”）

●Skin abscess, folliculitis, furuncle, carbuncle – Skin abscesses are collections of pus within the dermis and subdermal tissues (picture 5). Folliculitis is a superficial bacterial infection of the hair follicles with purulent material in the epidermis (picture 6 and picture 7). A furuncle is an infection of the hair follicle in which purulent material extends through the dermis into the subcutaneous tissue, leading to abscess formation. A carbuncle is a coalescence of several inflamed follicles into a single inflammatory mass with purulent drainage from multiple follicles. Furuncles and carbuncles can involve the gluteal skin (picture 8). These lesions can be differentiated from pilonidal infections by their distance from the midline. (See "Cellulitis and skin abscess: Epidemiology, microbiology, clinical manifestations, and diagnosis", section on 'Skin abscess'.)
皮膚膿腫、毛囊炎、癤、癤 –皮膚膿腫是真皮和皮下組織內的膿液聚集 （ 圖片 5）。毛囊炎是表皮有膿性物質的毛囊淺表細菌感染 （ 圖片 6 和 圖片 7）。癤是毛囊的感染，其中膿性物質通過真皮延伸到皮下組織，導致膿腫形成。癰是幾個發炎的毛囊合併成一個炎症腫塊，多個毛囊有膿性引流。癤和癤可累及臀肌皮膚 （ 圖片 8）。這些病變可以通過距中線的距離來區分藏毛體感染。（參見 “蜂窩織炎和皮膚膿腫的流行病學、微生物學、臨床表現和診斷”，關於'皮膚膿腫'一節 ）

●Hidradenitis suppurativa – Hidradenitis suppurativa is a chronic inflammatory condition of the skin that is characterized by painful subcutaneous nodules that can rupture and spur the development of subdermal abscesses and sinus tracts. Its distribution can include the axillary, inguinal, and perineal regions (picture 9 and picture 10). Hidradenitis suppurativa has some characteristics in common with pilonidal disease such as draining sinus tracts and abscesses, and some have postulated a common etiology between hidradenitis suppurativa and pilonidal disease [22,23]. However, hidradenitis is usually easily distinguished by its typical location in the perineal or inguinal area, rather than the natal cleft area. (See "Hidradenitis suppurativa: Pathogenesis, clinical features, and diagnosis".)
化膿性汗腺炎 – 化膿性汗腺炎是一種皮膚的慢性炎症性疾病，其特徵是疼痛的皮下結節，可破裂並刺激皮下膿腫和鼻竇道的發展。其分佈可包括腋窩、腹股溝和會陰區域 （ 圖片 9 和圖片 10）。化膿性汗腺炎與藏毛腺疾病有一些共同特徵，如引流性鼻竇和膿腫，一些人認為化膿性汗腺炎與藏毛腺病有共同的病因[22,23]。然而，汗腺炎通常很容易通過其在會陰或腹股溝區域而不是出生裂區域的典型位置來區分。（參見 “化膿性汗腺炎的發病機制、臨床特徵和診斷”）

●Systemic infection – In rare occasions, such as in immunocompromised hosts, systemic infectious processes such as tuberculosis, syphilis, and actinomycosis [24] can involve the gluteal region. Despite the unlikely involvement of the natal cleft, these patients will have historical and laboratory features that will allow these conditions to be differentiated from pilonidal disease.
全身感染 –在極少數情況下，如免疫功能低下的宿主，結核、梅毒和放線菌病等全身感染過程可累及臀區。 儘管不太可能受累出生唇裂，但這些患者將具有病史和實驗室特徵，可以將這些疾病與藏毛病區分開來。

NONSURGICAL MANAGEMENT FOR INACTIVE DISEASE
非活動性疾病的非手術治療 — 

In clinical practice, it is rare to encounter patients with pilonidal disease who do not have any symptoms or prior episodes of flare ups. Most with inactive pilonidal disease have had one or more episodes of previous episodes (eg, abscess or drainage), but the disease is presently quiescent.
在臨床實踐中，很少遇到沒有任何癥狀或既往發作的藏毛病患者。大多數非活動性藏毛病患者既往有過一次或多次發作（如膿腫或引流），但目前處於靜止狀態。

Due to the morbidity associated with most procedures performed to address pilonidal disease, we suggest against surgery for patients who have no symptoms from a pilonidal sinus. In a retrospective review of 26 patients with an incidental pilonidal sinus undergoing an excision and primary closure, the rate of healing following excision and primary closure was only 62 percent [25].
由於大多數為治療藏毛竇而進行的手術都存在併發症，因此我們建議對沒有藏毛竇癥狀的患者不要進行手術。一項回顧性評價納入了 26 例偶然藏毛竇患者，並接受切除和初次封堵術，結果顯示切除術和初次閉合術后的癒合率僅為 62%[25]。

In patients with inactive pilonidal disease, however, there may be a role for the removal of hair from the natal cleft, either by shaving or laser epilation, provided that there is no soft tissue infection present [26]. While there is only low-quality evidence supporting hair removal, the approach is low-cost, easy to implement, and associated with minimal risk of complications. Additionally, it targets a potential contributing factor to the disease: excess hair in the natal cleft.
然而，對於非活動性藏毛病患者，只要沒有軟組織感染，則可能通過剃鬚或激光脫毛去除出生間裂的毛髮[26]。雖然只有低質量的證據支持脫毛，但該方法成本低、易於實施，並且併發症風險最小。此外，它還針對導致該疾病的潛在因素：出生裂中毛髮過多。

Improved hygiene, hair removal, and lifestyle modification have been associated with a decrease in disability days and the need for operation [27]. There is also evidence that improved hygiene and regular shaving reduce recurrence rates after operative interventions such as trephination or excision [28].
改善衛生、脫毛和改變生活方式與殘疾天數的減少和手術需求有關[27]。還有證據表明，改善衛生習慣和定期剃鬚可降低環鑽或切除等手術干預后的復發率[28]。

Epilation techniques with either laser or intense pulse light may be more effective than shaving and chemical hair removal because they remove the hair shaft, follicle, and bulb. In a small randomized trial, laser epilation reduced the one-year recurrence rate from 34 to 10 percent [29]. However, there was no statistically significant reduction in emergency room or hospital visits or surgical procedures, and laser epilation requires more resources.
使用鐳射或強脈衝光的脫毛技術可能比剃鬚和化學脫毛更有效，因為它們可以去除毛乾、毛囊和球莖。一項小型隨機試驗顯示，激光脫毛可將 1 年復發率從 34%降低至 10%[29]。然而，急診室或醫院就診或外科手術沒有統計學上的顯著減少，激光脫毛需要更多的資源。

Phenol or fibrin glue has been injected into pilonidal sinus tracts as a primary treatment [30-32]. There is no high-quality evidence that either is as effective as more established surgical treatments such as trephination or excision [33].
苯酚或纖維蛋白膠已注射到藏毛竇道作為主要治療方法[30-32]。尚無高質量證據表明，這兩種方法都與環鑽或切除等更成熟的手術治療一樣有效[33]。

SURGICAL MANAGEMENT FOR ACTIVE DISEASE
活動性疾病的手術治療 — 

The surgical management of pilonidal disease is variable and depends on the presence or absence of an infection (algorithm 1).
藏毛菌病的手術治療是可變的，取決於有無感染 （ 流程圖 1）。

Abscess — For most patients with a pilonidal abscess, we suggest prompt incision and drainage at the time of presentation.
膿腫  —  對於大多數藏毛膿腫患者，我們建議在就診時立即切開引流。

Surgical drainage — The incision is generally performed over the area of maximal fluctuance. In general, a smaller incision is adequate if a drain is placed to prevent premature closure of the incision site. This approach is also helpful in avoiding the need for patient-directed wound care such as wound packing.
手術引流  —  切口通常在最動區域進行。一般來說，如果放置引流管以防止切口部位過早閉合，則較小的切口就足夠了。這種方法也有助於避免需要以患者為導向的傷口護理，例如傷口包紮。

If a larger incision is deemed necessary, this often requires an operating room setting with a general anesthetic. In these circumstances, the removal of inflammatory debris and visible hair may be appropriate [7,34,35]. In one randomized trial, unroofing and curettage of the abscess cavity resulted in superior healing (96 versus 79 percent) and fewer recurrences (10 versus 54 percent) compared with drainage alone [36]. Larger wounds are typically treated with saline gauze wet-to-dry dressings, with healing by secondary intention.
如果認為有必要進行更大的切口，這通常需要手術室設置並使用全身麻醉。在這些情況下，去除炎性碎片和可見毛髮可能是合適的[7,34,35]。一項隨機試驗顯示，與單獨引流相比，膿腫腔的開頂和刮除術癒合率更高（96% vs 79%），復發率更低（10% vs 54%）[36]。較大的傷口通常使用鹽水紗布濕-干敷料治療，並通過次要意圖癒合。

Role of antibiotics — Antibiotics would only be adequate for the treatment of diminutive (<3 cm) collections. For abscesses treated with drainage, antibiotics are not required unless there are systemic symptoms of infection, such as fevers, extensive cellulitis, or the patient is immunocompromised, including poorly controlled diabetes [26]. The most common organisms isolated in chronic pilonidal disease are aerobes, whereas anaerobes such as bacteroides predominate in abscesses. A reasonable antibiotic choice would be a first-generation cephalosporin (such as cefazolin) plus metronidazole. The management of cellulitis is reviewed separately. (See "Acute cellulitis and erysipelas in adults: Treatment".)
抗生素  的作用 —  抗生素僅適用於治療體型較小（<3 cm）的藏品。對於引流治療的膿腫，除非有全身感染癥狀，如發熱、廣泛蜂窩織炎，或患者免疫功能低下，包括糖尿病控制不佳，否則不需要抗生素[26]。在慢性藏毛菌病中分離出的最常見的微生物是需氧菌，而擬桿菌等厭氧菌在膿腫中佔主導地位。合理的抗生素選擇是第一代頭孢菌素（如頭孢唑啉 ）加甲硝唑 。蜂窩織炎的治療詳見其他專題。（參見 “成人急性蜂窩織炎和丹毒的治療”）

Follow-up care — Following the healing of a drained pilonidal abscess, we suggest regular gluteal cleft shaving or another method of epilation (eg, laser). (See 'Nonsurgical management for inactive disease' above.)
隨訪  —  引流的藏毛膿腫癒合后，我們建議定期進行臀裂剃鬚或其他脫毛方法（如鐳射）。（參見上文 '非活動性疾病的非手術治療'）

It is possible to develop recurrent pilonidal abscesses following drainage of an index pilonidal abscess. The recurrence rates reported in the literature ranged from 10 to 55 percent, with the presence of multiple pores and lateral sinus tracts corresponding with higher rates [26,35,37]. (See 'Chronic disease' below.)
指數藏毛膿腫引流後可能會發展為復發性藏毛膿腫。文獻報導的復發率在 10%-55%之間，存在多個孔和外側竇道的復發率較高[26,35,37]。（參見下文 '慢性疾病'）

There are no data regarding whether definite excision of all skin pits and tracks that constitute the patient's pilonidal disease is necessary or helpful to prevent recurrence. Patients who develop recurrent abscesses should be counseled regarding definitive surgery after their infection has been resolved. (See 'Chronic disease' below.)
沒有數據表明是否有必要或有助於明確切除構成患者藏毛病的所有皮膚凹坑和痕跡來預防復發。發生復發性膿腫的患者應在感染消退後諮詢根治性手術。（參見下文 '慢性疾病'）

Chronic disease — Chronic pilonidal disease presents with either recurrent abscesses with intervening periods of healing or one or more persistently draining sinuses that may be associated with a nonhealing wound. In either case, the definitive treatment is surgical [26]. However, the decision for surgery should be based on the severity of symptoms as perceived by the patient and the impact of those episodes on the patient's quality of life, rather than on arbitrary criteria such as the number of episodes (algorithm 1).
慢性疾病  —  慢性藏毛囊病表現為復發性膿腫，中間有癒合期，或一個或多個持續引流的鼻竇，可能與未癒合的傷口有關。無論哪種情況，最終的治療都是手術[26]。然而，手術的決定應基於患者感知的癥狀嚴重程度和這些發作對患者生活質量的影響，而不是根據發作次數等任意標準 （ 流程圖 1）。

Limited disease — There is increasing evidence that for limited pilonidal disease, wide local excision of the natal cleft skin is not necessary [26,33,38-40]. What constitutes limited as opposed to extensive disease, however, is not universally agreed [19]. Nevertheless, most reports would consider a few (one or two) pits or sinuses without significant lateral extension as limited disease [40-42].
局限性疾病  —  越來越多的證據表明，對於局限性藏毛蟲病，無需對出生體裂皮膚進行廣泛的局部切除[26,33,38-40]。然而，局限性疾病與廣泛性疾病並無普遍認同[19]。然而，大多數報導認為少數（1 或 2 個）無明顯側向伸展的凹坑或鼻竇為局限性疾病[40-42]。

All minimally invasive treatment of limited pilonidal disease entails removal of the midline pits/sinuses, beyond which various techniques diverge. Some treatments also drain/debride secondary tracks or cavities via the pits/sinuses (eg, the Gips procedure or endoscopic technique). Other treatments fill the tracks or cavities with either phenol or fibrin glue to obliterate them. Some minimally invasive techniques can be performed in the office under local anesthetics; others are performed in the operating room as day surgery.
局限性藏毛病的所有微創治療都需要切除中線凹坑/鼻竇，除此之外，各種技術也有所不同。一些治療還通過凹坑/鼻竇引流/清創次要軌道或空腔（例如，Gips 手術或內鏡技術）。其他治療用苯酚或纖維蛋白膠填充足跡或空腔以消除它們。一些微創技術可以在局部麻醉下在辦公室進行;其他的則作為日間手術在手術室進行。

●Pit-picking procedures (eg, Bascom I procedure, Gips procedure) – The original Bascom pit-picking procedure excises the pits with a knife [43], while the Gips procedure utilizes trephines (dermatologic skin punches) of various diameters to excise the pits and debride underlying cavities and tracts [44]. The otherwise healthy skin bridges in between are preserved, thus reducing pain and wound morbidities (figure 4). Trephination has been reported to have healing rates of approximately 90 percent, with recurrence rates of 16 percent [45]. Advantages of this technique include small incisions, the absence of wound packing as the patient's responsibility, and the ease of repeating this procedure or another type of surgery should recurrences develop.
取坑術（如 Bascom I 型取核術、Gips 取核術）–原始 Bascom 取核取法用刀切除果核[43]，而 Gips 取核手術則利用各種直徑的環蟲（皮膚科皮膚沖劑）切除果核，並清創下面的蛀牙和道[44]。中間原本健康的皮膚橋得以保留，從而減輕疼痛和傷口併發症（ 圖 4）。據報導，環鑽的癒合率約為 90%，復發率為 16%[45]。該技術的優點包括切口小、無需將傷口包紮作為患者的責任，以及在復發時易於重複此手術或其他類型的手術。

●Video-assisted ablation of pilonidal sinus is a minimally invasive treatment based on the complete removal of the sinus cavity through a minimal surgical wound [46]. In a small trial comparing this endoscopic technique with conventional surgical excision, video-assisted ablation achieved fewer wound infections (1.3 versus 7.2 percent), less pain, quicker return to work (1.6 versus 8.2 days), and higher patient satisfaction [47].
藏毛竇視頻輔助消融術是一種微創治療，其基礎是通過最小的手術創面完全切除鼻竇腔[46]。一項小型試驗將這種內鏡技術與傳統手術切除進行了比較，發現視頻輔助消融術的傷口感染更少（1.3% vs 7.2%）、疼痛更少、恢復工作更快（1.6 vs 8.2 日）和患者滿意度更高[47]。

●Phenol injection has been used in lieu of surgical excision in selected patients with chronic pilonidal disease. Crystallized phenol solution can be injected into the sinus tract; phenol creates a caustic reaction without creating pain given that the phenol solution can have analgesic effects. Further, phenol denatures hair that likely contributes to pilonidal disease. After debriding the tract, 1 to 3 mL of phenol is instilled, protecting the surrounding skin with ointment. Often, more than one session is required to achieve good results. Along with gluteal cleft hair control, one or more applications of phenol had success rates ranging from 60 to 95 percent and few recurrences [48-50]. It has been used in combination with pit excision [51] or with laser epilation [49]. Depending on the patient and the number of sinuses, phenol can be administered in a clinic setting without sedation.
苯酚注射液已被用於代替手術切除，用於特定慢性藏毛病患者。結晶的苯酚溶液可注射到鼻竇道中;苯酚會產生腐蝕性反應而不會產生疼痛，因為苯酚溶液可以產生鎮痛作用。此外，苯酚會使頭髮變性，可能導致藏毛病。清創后，滴入 1 至 3mL 苯酚，用軟膏保護周圍皮膚。通常，需要不止一次治療才能取得良好的效果。除了控制臀裂毛髮外，一次或多次苯酚應用的成功率在 60%-95%之間，復發率很少[48-50]。它已與凹坑切除術[51]或激光脫毛[49]聯合使用。根據患者和鼻竇數量，苯酚可以在診所環境中使用，無需鎮靜。

●Fibrin glue has been used either as a monotherapy to fill the sinus tract or as an adjunct to surgery to seal the excision bed. However, a Cochrane review did not find sufficient evidence for its benefit because the studies were small and at high risk of bias [52].
纖維蛋白膠已被用作填充鼻竇道的單一療法或作為密封切除床的手術的輔助手段。然而，一項 Cochrane 綜述沒有發現足夠的證據證明其有益處，因為這些研究規模較小且偏倚風險高[52]。

The main advantage of minimally invasive techniques is less pain and faster recovery compared with excisional techniques [47,53,54]. In two meta-analyses, the recurrence rates were similar for both minimal surgical interventions and the more extensive procedures, which ranged from 1 to 8.5 (interquartile range 1.9 to 2.8) percent after minimal surgical techniques, and from 0.2 to 5 (1 to 2.8) percent after more extensive surgery [55,56]. There was a substantial increase in recurrence with time after all procedures.
與切除技術相比，微創技術的主要優點是疼痛更小、恢復更快[47,53,54]。2 項 meta 分析顯示，最小手術干預和更廣泛手術的復發率相似，最小手術技術后的復發率為 1%-8.5%（四分位數範圍為 1.9-2.8%）%，更廣泛手術后的復發率為 0.2%-5（1-2.8%）%[55,56]。所有手術后，隨著時間的推移，復發率大幅增加。

Extensive disease — The mainstay of operative management for extensive pilonidal disease is the excision of all sinus tracts, which includes all subdermal granulation tissue. Some surgeons prefer to extend the depth of their excision to the investing fascia of the sacrum (figure 4); while this may be necessary for certain distributions of disease, it also creates a larger wound. In some circumstances, a lesser debridement that unroofs sinus tracts without excision may be employed (ie, the lay-open or deroofing techniques) [57,58]. While the optimal technique is debated, there is agreement that normal tissue should be preserved as much as possible to facilitate wound healing, as higher volumes of excised tissue have been associated with increased rates of wound failure [59]. The value of using methylene blue to identify associated sinus tracts is debatable and based on low-quality data [60,61].
廣泛性疾病  —  廣泛性藏毛病的手術治療主要方法為切除所有鼻竇道，包括所有皮下肉芽組織。一些外科醫生更願意將切除深度擴展到骶骨的陷膜 （ 圖 4）;雖然這對於疾病的某些分佈可能是必要的，但它也會造成更大的傷口。在某些情況下，可採用較小的清創術，即在不切除的情況下將鼻竇道拆除（即，開鑿或去頂技術）[57,58]。雖然最佳技術存在爭議，但一致認為應盡可能保留正常組織以促進傷口癒合，因為切除組織的體積越大，傷口衰竭率越高[59]。使用亞甲藍識別相關鼻竇道的價值存在爭議，並且基於低質量的數據[60,61]。

Traditionally, options for wound management without a flap would include either primary closure or wound healing by secondary intention. A primary closure is associated with faster wound healing (eg, 15 versus 60 days [62]) and a faster return to work (eg, 12 versus 18 days [63]), but a delayed closure is associated with 35 percent fewer recurrences (5.3 versus 8.7 percent) according to a 2010 Cochrane review of 26 randomized trials including 2530 patients [64].
傳統上，沒有皮瓣的傷口處理選擇包括初次閉合或次要意圖傷口癒合。2010 年一項 Cochrane 綜述納入了 26 項隨機試驗，包括 2530 例患者，原發性閉合與創面癒合較快（如 15 日 vs 60 日[62]）和更快恢復工作（如 12 日 vs 18 日[63]）相關，但延遲閉合與復發率降低 35%相關（5.3% vs 8.7%）[64]。

Delayed wound closure (secondary intention) — Open wounds are treated by dressing changes until healed by secondary intention. Options of dressing include (see "Principles of acute wound management", section on 'Wound packing'):
延遲傷口閉合（次要意圖） —  開放性傷口通過更換敷料進行治療，直至次要意圖癒合。敷料的選擇包括（參見 “急性傷口處理的原則”，關於'傷口填塞'一節 ）：

●Alginates   海藻酸鹽

●Hydrocolloids  親水膠體

●Topical antimicrobials   外用抗菌藥物

●Foam dressings   泡沫敷料

●Hydrogels   水 凝 膠

The surgeon may choose any dressing, as a 2022 Cochrane review of 11 trials did not find any high-certainty evidence that any of the dressings or topical agents had a benefit on time to wound healing or the proportion of wounds that heal at a specific time point [65].
外科醫生可以選擇任何敷料，因為 2022 年 Cochrane 綜述納入了 11 項試驗，沒有發現任何高質量證據表明任何敷料或外用藥物對創面癒合的時間或在特定時間點癒合的創面比例有益[65]。

An alternative method for managing the open wound is the use of negative pressure wound therapy (NPWT), perhaps best reserved for very large defects. However, the Cochrane review could not be certain if NPWT reduced time to healing or increased wound healing rates compared with conventional dressings based on two trials [65].
治療開放性傷口的另一種方法是使用負壓傷口治療 （NPWT），這也許最好用於非常大的缺損。然而，基於 2 項試驗的 Cochrane 綜述無法確定與傳統敷料相比，NPWT 是否縮短了癒合時間或提高了傷口癒合率[65]。

The same Cochrane review also found low‐certainty evidence on the benefit of platelet‐rich plasma from two trials [66]. A subsequent trial found benefits in using platelet-rich plasm as an adjunct to phenol in children [67].
同一項 Cochrane 系統綜述還發現，2 項試驗顯示富血小板血漿獲益的證據品質低[66]。隨後的一項試驗發現，兒童使用富血小板血漿作為苯酚的輔助手段有益[67]。

Delayed closure techniques may either leave the wound open or marsupialize the skin edges to the sacrococcygeal fascia (figure 5). Proponents of marsupialization believe that it reduces both healing time (compared with a completely open wound) and recurrence rates (compared with primary closure) [68-70]. Due to a lack of high-quality comparative data, however, neither technique can be declared to be the superior choice.
延遲閉合技術可能會使傷口保持開放，或使皮膚邊緣有袋動物化至骶尾骨筋膜 （ 圖 5）。有袋動物化的支援者認為，它能縮短癒合時間（與完全開放性傷口相比）和復發率（與原發性閉合相比）[68-70]。然而，由於缺乏高品質的比較數據，這兩種技術都不能被宣佈為更好的選擇。

Primary wound closure — Primary wound closure can be accomplished by either midline (figure 6) or off-midline techniques (figure 7) [64,71]:
原發性傷口閉合  —  原發性創面閉合可採用中線 （ 圖 6）或離中線技術 （ 圖 7）[64,71]：

●Midline primary closure involves reapproximating the edges of the skin and subcutaneous tissue in the midline, usually using several layers of sutures.
中線初次閉合涉及重新接近中線皮膚和皮下組織的邊緣，通常使用幾層縫合線。

●Off-midline primary closure requires more planning. The initial incision is typically made at a location lateral to the midline, with its location dependent on the closure technique. Following excision or unroofing of the pilonidal sinus tracts, a skin and subcutaneous tissue flap is raised to cover the midline defect. The incision is then closed off the midline with several layers of sutures. Off-midline closure is technically more demanding but can cover a wider defect and may result in less tension at the suture line. Techniques commonly used to ensure an off-midline closure are discussed below. (See 'Techniques of primary off-midline closure' below.)
偏離中線原發性閉合需要更多的計劃。初始切口通常在中線外側的位置進行，其位置取決於閉合技術。在切除或去除藏毛竇道后，抬起皮膚和皮下組織皮瓣以覆蓋中線缺損。然後用幾層縫合線將切口從中線處閉合。偏中線閉合在技術上要求更高，但可以覆蓋更廣泛的缺損，並可能導致縫合線處的張力較小。下文將討論用於確保偏離中線閉合的常用技術。（參見下文 '原發性偏中線閉合術'）

For patients undergoing a primary wound closure, we recommend an off-midline (lateral) closure rather than a midline closure. Off-midline (lateral) closure techniques have been associated with less wound dehiscence (3.9 versus 8.9 percent), fewer infectious complications (3.8 versus 11.7 percent), shorter healing time (mean difference 5.2 days, 95% CI 2.9-7.6 days), and fewer recurrences (1.5 versus 6.8 percent) compared with simple midline closure techniques, according to a Cochrane meta-analysis of 33 trials [72].
對於接受原發性傷口閉合的患者，我們建議進行偏中線（側向）閉合，而不是中線閉合。一項納入 33 項試驗的 Cochranemeta 分析顯示，與單純中線閉合技術相比，非中線（側向）閉合技術的創面裂開較少（3.9% vs 8.9%）、感染併發症較少（3.8% vs 11.7%）、癒合時間較短（平均差異為 5.2 日，95%CI 2.9-7.6 日）和復發率較少（1.5% vs 6.8%）[72]。

Techniques of primary off-midline closure — While an off-midline approach to primary closure is preferred, the optimal procedure has not been identified, despite multiple randomized trials [73,74]. As such, surgeons should choose a technique based on the extent of the resection and their experience [35,64,68].
原發性離中線封堵  術 —  雖然首選偏離中線封堵術，但儘管有多項隨機試驗，但尚未確定最佳手術[73,74]。因此，外科醫生應根據切除範圍和經驗來選擇技術[35,64,68]。

The Karydakis flap and Bascom cleft-lift procedure can be used for initial surgical management or for recurrent disease. Rhomboid, V-Y, and other rotational flap reconstructions are typically reserved for patients with more extensive disease or those who have failed simpler operations [11].
Karydakis 皮瓣和 Bascom 唇裂提升手術可用於初始手術治療或復發性疾病。菱形瓣重建術、V-Y 型和其他旋轉皮瓣重建術通常適用於疾病範圍較廣的患者或簡單手術失敗的患者[11]。

●Karydakis flap – The Karydakis flap involves excising diseased tissue with an elliptical surgical site, with the cephalad and caudal edges of the wound being 2 cm off midline. A fasciocutaneous flap is then mobilized from the contralateral aspect of the natal cleft, covering the wound with an off-midline wound closure performed in several layers (figure 8) [75]. It achieves a recurrence rate of <5 percent and a wound complication rate of 7 to 21 percent, depending on studies [76-78].
Karydakis 皮瓣 – Karydakis 皮瓣涉及用橢圓形手術部位切除病變組織，傷口的頭側和尾部邊緣偏離中線 2 釐米。然後從出生裂的對側動員筋膜皮瓣，用多層的偏中線創面閉合覆蓋創面 （ 圖 8）[75]。根據研究，該病的復發率為<5%，創面併發症發生率為 7%-21%[76-78]。

●Cleft-lift (Bascom) procedure – This technique "lifts" the normally concave natal cleft, creating an off-midline suture line, obliterating the cleft [79]. Literature on this technique describes marking a "safety zone" defined by where the gluteal tissues are able to contact one another after the gluteal cleft is brought together. The diseased tissue is excised, raising a flap from one side of the cleft that is brought to the contralateral side to cover the soft tissue defect. The primary healing rates were 80 to 96 percent, and the recurrence rate was 0 to 17 percent [80-83]. Here is a sample video of this procedure (movie 1). A meta-analysis of six randomized trials comparing Karydakis/Bascom procedures with the Limberg procedure found no difference in recurrence or wound complications rate [84].
裂隙提升術（Bascom）手術 –該技術“提升”通常凹陷的出生裂，形成一條偏離中線的縫合線，消除裂隙[79]。有關該技術的文獻描述了標記一個「安全區」，定義為臀裂聚集后臀組織能夠相互接觸的位置。切除病變組織，從裂隙的一側抬起一個皮瓣，該皮瓣被帶到對側以覆蓋軟組織缺損。原發性癒合率為 80%-96%，復發率為 0%-17%[80-83]。這是此過程的示例視頻（ 視頻 1）。一項 meta 分析納入了 6 項隨機試驗，比較了 Karydakis/Bascom 手術與 Limberg 手術，發現復發率和創面併發症發生率沒有差異[84]。

●Rhomboid (Limberg) flap – The rhomboid or Limberg flap is a rotational fasciocutaneous flap that permits primary off-midline closure of the wound and flattening of the gluteal cleft (figure 9) [85]. Here is a sample video of this technique (movie 2). Here are two photos of completed rhomboid flaps (picture 11 and picture 12). The reported recurrence rate (0 to 6 percent) and surgical infection rate (0 to 6 percent) are both low and in several studies compare favorably with those of simple midline closure [86-88].
菱形皮瓣 –菱形皮瓣或 Limberg 皮瓣是一種旋轉性筋膜皮瓣，可使創面原發性偏離中線閉合，並使臀裂變平 （ 圖 9）[85]。這是該技術的示例視頻（ 視頻 2）。這是兩張完整的菱形皮瓣的照片（ 圖 11 和圖 12）。報告的復發率（0%-6%）和手術感染率（0%-6%）均較低，一些研究與單純中線閉合術相比具有優勢[86-88]。

●V-Y advancement flap – A V-Y advancement flap is another technique of excising pilonidal disease and closing the wound defect (figure 10). Healing rates of >90 percent and low recurrence rates have been reported in case series [89,90].
V-Y 前移皮瓣 –V-Y 前移皮瓣是另一種切除藏毛病和閉合傷口缺損的技術（ 圖 10）。病例系列報導的癒合率為>90%，復發率較低[89,90]。

●Z-plasty – Pilonidal sinuses can be excised and the defect reconstructed using a standard Z-plasty (figure 11 and figure 12). Here is a photo of pilonidal disease successfully treated with Z-plasty (picture 13). The rationale and technique of Z-plasty is discussed elsewhere. (See "Z-plasty" and "Overview of flaps for soft tissue reconstruction", section on 'Introduction'.)
Z 形成形術 – 可以切除藏毛竇，並使用標準 Z 形成形術重建缺損（ 圖 11 和 圖 12）。這是一張用 Z 型成形術成功治療的藏毛病的照片 （ 圖片 13）。Z 形成形術的基本原理和技術詳見其他專題。（參見 “Z 型成形術” 和 “軟組織重建皮瓣概述”，關於'引言'一節 ）

For patients who have primary wound closure, a drain may be used on a case-by-case basis at the surgeon's discretion. Drains have been shown to reduce the incidence of wound complications such as fluid collections but not impact wound infection or recurrence rates [76,91,92]. Drain is best based on the size of the flap utilized and thus the volume of potential dead space following reconstruction. Drain removal is based upon surgeon judgment but is typically safe once drains produce 20 mL or less for two consecutive days.
對於原發性傷口閉合的患者，外科醫生可根據具體情況判斷使用引流管。引流管已被證明可以降低傷口併發症（如積液）的發生率，但不會影響傷口感染或復發率[76,91,92]。引流管最好根據所用皮瓣的尺寸以及重建后潛在死腔的體積。引流管的移除取決於外科醫生的判斷，但一旦引流管連續兩天產生 20 mL 或更少，通常是安全的。

Hygiene involving hair removal is generally recommended after surgical excision of pilonidal disease to prevent recurrence (see 'Nonsurgical management for inactive disease' above). However, studies of using laser epilation adjunctively after surgical excision of pilonidal disease reported discordant results [29,93], possibly due to heterogeneity in disease severities and nonstandardized definition of recurrences [94].
手術切除藏毛菌病后，通常建議採取脫毛衛生措施，以防止復發（參見上文 』非活動性疾病的非手術治療『）。然而，關於手術切除藏毛腺疾病后輔助使用激光脫毛的研究報告了結果不一致[29,93]，這可能是由於疾病嚴重程度的異質性和復發的定義不規範[94]。

INFORMATION FOR PATIENTS
患者教育 — 

UpToDate offers two types of patient education materials, "The Basics" and "Beyond the Basics." The Basics patient education pieces are written in plain language, at the 5^th to 6^th grade reading level, and they answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are written at the 10^th to 12^th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon.
UpToDate 提供兩種類型的患者教育材料，即“基礎”和“超越基礎”。基礎患者教育文章以通俗易懂的語言編寫，適合 5 ^{至 6 年級的}閱讀水準，它們回答了患者可能對特定疾病提出的四五個關鍵問題。這些文章最適合想要一般概述和喜歡簡短、易於閱讀材料的患者。Beyond the Basics 患者教育文章更長、更複雜、更詳細。這些文章是在 10 ^至 12 ^年級閱讀水準上寫的，最適合想要深入資訊並熟悉一些醫學術語的患者。

Here are the patient education articles that are relevant to this topic. We encourage you to print or e-mail these topics to your patients. (You can also locate patient education articles on a variety of subjects by searching on "patient info" and the keyword(s) of interest.)
以下是與此主題相關的患者教育文章。我們鼓勵您將這些主題列印或通過電子郵件發送給您的患者。（您還可以透過搜索“患者資訊”和感興趣的關鍵字來找到有關各種主題的患者教育文章。

●Basics topics (see "Patient education: Pilonidal cyst (The Basics)")
基礎篇（參見 “患者教育：藏毛囊腫（基礎篇）”）

SUMMARY AND RECOMMENDATIONS
總結與推薦

●Epidemiology – Pilonidal disease is a suppurative condition involving the skin and subcutaneous tissue at or near the upper part of the natal cleft between the buttocks. It is most seen in patients in their late teens and early twenties, with a male predominance. It is less frequently seen in children and in those older than 45 years. (See 'Introduction' above and 'Anatomy' above and 'Epidemiology' above.)
流行病學 – 藏毛病是一種化膿性疾病，涉及臀部之間出生裂上部或附近的皮膚和皮下組織。它最常見於十幾歲和二十出頭的患者，以男性為主。它在兒童和 45 歲以上的人群中較少見。（參見上文 '引言' 和 '解剖學' 和' 流行病學'）

●Clinical presentation and diagnosis – The clinical presentation is highly variable, ranging from an asymptomatic pilonidal sinus to an acute infection or chronic exacerbation with inflammation and drainage. The physical findings include one or more primary pores (pits) in the midline of the natal cleft with or without a painless sinus opening(s) cephalad and slightly lateral to one side (figure 1). For patients with acute or chronic disease, a tender mass or sinus draining mucoid, purulent, and/or bloody fluid can be identified. Diagnosis is clinical without the need for laboratory or imaging studies. (See 'Clinical manifestations' above and 'Diagnosis' above.)
臨床表現和診斷 – 臨床表現差異很大，從無癥狀的藏毛竇到急性感染或慢性惡化伴炎症和引流。體格檢查結果包括出生裂中線的一個或多個原發性孔（凹坑），伴或不伴無痛性鼻竇開口（頭側）和側側（ 圖 1）。對於急性或慢性疾病患者，可以識別壓痛腫塊或鼻竇引流粘液、膿性和/或血性液體。診斷是臨床的，不需要實驗室或影像學檢查。（參見上文 '臨床表現' 和 '診斷'）

●Inactive disease – For patients who have a pilonidal sinus but no active symptoms, we suggest regular gluteal cleft shaving or another method of epilation (eg, laser), rather than any surgical treatment (Grade 2C). This approach is low cost, low risk, easy to implement, and addresses cleft hair, which has been implicated in the pathogenesis of pilonidal disease. Surgical excision of pilonidal disease can potentially lead to significant wound morbidities. (See 'Nonsurgical management for inactive disease' above.)
非活動性疾病 –對於有藏毛竇但無活動性癥狀的患者，我們建議定期進行臀裂剃鬚或其他脫毛方法（如鐳射），而不是任何手術治療（2C 級 ）。這種方法成本低、風險低、易於實施，並解決與藏毛病發病機制有關的裂隙毛髮問題。手術切除藏毛病可能會導致嚴重的傷口發病率。（參見上文 '非活動性疾病的非手術治療'）

●Active disease – Patients with active symptoms from pilonidal disease require surgical treatment, the extent of which depends on the acuity and severity of their presentation (algorithm 1) (see 'Surgical management for active disease' above):
活動性疾病 –有藏毛病活動性癥狀的患者需要手術治療，手術治療的程度取決於其表現的嚴重程度和嚴重程度 （ 流程圖 1） （參見上文 '活動性疾病的手術治療'）：

•Acute abscess – Most patients with a pilonidal abscess require prompt incision and drainage at the time of presentation. Antibiotics are not required unless there are systemic symptoms of infection such as fevers, extensive cellulitis, or the patient is immune suppressed including poorly controlled diabetes. (See 'Abscess' above.)
急性膿腫 – 大多數藏毛膿腫患者在就診時需要及時切開和引流。除非有全身感染癥狀，如發燒、廣泛蜂窩織炎，或患者免疫抑制，包括糖尿病控制不佳，否則不需要抗生素。（參見上文 '膿腫'）

•Chronic disease – Patients with chronic symptoms (eg, pain, drainage) require surgical excision tailored to the extent of their diseases (figure 4) (see 'Chronic disease' above):
慢性疾病 –有慢性癥狀（如疼痛、引流）的患者需要根據其疾病程度進行手術切除（ 圖 4）（參見上文 '慢性疾病'）：

-Limited disease – For patients with one or two pits/sinuses at midline, we suggest minimally invasive treatment rather than full excision (Grade 2C). Minimally invasive treatment only removes the midline pits/sinuses and debrides, rather than excises the sinus tracks. Phenol or fibrin glue may also be injected to obliterate the tracks. (See 'Limited disease' above.)
疾病有限 – 對於中線有一個或兩個凹坑/鼻竇的患者，我們建議微創治療而不是完全切除（2C 級 ）。微創治療僅去除中線凹坑/鼻竇和缺口，而不是切除鼻竇軌道。也可以注入苯酚或纖維蛋白膠來消除痕跡。（參見上文 '局限性疾病'）

-Extensive disease – Patients who have more extensive disease require full excision of all sinus tracts and skin pores (pits), followed by wound management. (See 'Extensive disease' above.)
廣泛性疾病 – 患有更廣泛疾病的患者需要完全切除所有鼻竇道和皮膚毛孔（凹坑），然後進行傷口處理。（參見上文 '廣泛性疾病'）

●Wound management – Following excision of pilonidal disease, options include leaving the wound open or marsupialization versus primary wound closure. A primary closure is associated with faster wound healing and a faster return to work, but a delayed (open) closure is associated with fewer recurrences. (See 'Delayed wound closure (secondary intention)' above.)
傷口處理 – 切除藏毛病后，選擇包括保持傷口開放或有袋動物化與原發性傷口閉合。原發性閉合與更快的傷口癒合和更快的恢復工作有關，但延遲（開放性）閉合與更少的復發有關。（參見上文 '延遲傷口閉合（次要意圖）'）

•For patients undergoing a primary wound closure, we recommend an off-midline (lateral) closure rather than a midline closure (Grade 1B). Off-midline closures reduce complication rates, healing time, and recurrence rates compared with midline closure. (See 'Primary wound closure' above.)
對於接受原發性傷口閉合的患者，我們建議進行偏離中線（側向）閉合，而不是中線閉合（1B 級 ）。與中線閉合相比，偏離中線封堵可降低併發症發生率、癒合時間和復發率。（參見上文 '原發性傷口閉合'）

•For off-midline primary closure, the Karydakis flap and Bascom cleft-lift procedure can be used for initial surgical management or recurrent disease. Rhomboid, V-Y, and other rotational flap reconstructions are typically reserved for patients with more extensive disease or those who have failed simpler operations. (See 'Techniques of primary off-midline closure' above.)
對於偏離中線的初次封堵，Karydakis 皮瓣和 Bascom 裂提升手術可用於初始手術治療或復發性疾病。菱形、V-Y 和其他旋轉皮瓣重建通常保留給患有更廣泛疾病的患者或簡單手術失敗的患者。（參見上文 '原發性偏中線閉合術'）

ACKNOWLEDGMENT  確認 — 

The UpToDate editorial staff acknowledges Eric K Johnson, MD, FACS, FASCRS, who contributed to earlier versions of this topic review.
UpToDate 編輯人員感謝 Eric K Johnson，醫學博士、FACS、FASCRS，他為本專題綜述的早期版本做出了貢獻。