脐尿管疾病的诊治研究及文献复习(附14例报告)

目的：探讨脐尿管疾病的诊断与治疗方法。方法：根据病史并结合经脐孔或膀胱美蓝灌注试验、膀胱镜检查、瘘管造影、B超、CT等辅助检查方法诊断为脐尿管异常疾病14例，并进行相应手术治疗。结果：手术及病理检查证实为脐尿管瘘并感染2例。脐尿管囊肿并感染5例。脐尿管窦道并感染5例。原发性脐尿管鳞状细胞癌1例。患者术后排尿正常。8～18d痊愈出院。1例脐尿管瘘并感染者拒绝手术出院。结论：经脐孔或膀胱美蓝灌注试验、膀胱镜检查、瘘管造影、B超、CT等辅助检查为脐尿管疾病有效的诊断措施；手术范围应以尽可能彻底切除脐尿管及其异常组织为宜。     

先天性脐尿管异常疾病的诊治体会（附9例报告）

目的：探讨先天性脐尿管异常疾病的诊断与治疗方法。方法：根据病史并结合脐孔或膀胱美蓝注射试验、膀胱镜检查、瘘管造影、B超、CT等辅助检查方法诊断脐尿管异常疾病9例,并进行相应手术治疗。结果：手术及病理检查证实脐尿管瘘并感染3例,脐尿管囊肿并感染3例,脐尿管窦道并感染1例,膀胱顶部憩室1例,确诊后自动出院1例。患者术后排尿正常,8－18天痊愈出院,随访至今无复发及癌变。结论：脐孔或膀胱美蓝注射试验、膀胱镜检查、瘘管造影、B超、CT等辅助检查为有效的诊断措施;手术范围应以尽可能彻底切除脐尿管及其异常组织为宜。     

腹腔镜脐尿管囊肿切除合并膀胱部分切除术治疗脐尿管囊肿(附2例报告)

目的探讨腹腔镜脐尿管囊肿切除合并膀胱部分切除术治疗脐尿管囊肿的可行性及疗效。方法 2例脐尿管囊肿患者均行腹腔镜脐尿管囊肿切除合并膀胱部分切除术,分析诊断及治疗过程,随访疗效。结果 2例手术过程均顺利,无大出血、周围脏器损伤等,术后无感染、漏尿等并发症发生。术后随访1年,囊肿无复发,无明显腹痛及泌尿系统感染表现。结论脐尿管囊肿术前明确诊断至关重要。腹腔镜手术方法治疗脐尿管囊肿疗效确切、囊肿切除彻底,且手术创伤小、术后恢复快,是治疗脐尿管囊肿安全可行的方法,可作为目前治疗脐尿管囊肿的首选方法。     

脐尿管未闭异位开口的诊断治疗(附2例报告)

目的:探讨先天性脐尿管未闭异位开口的诊断与治疗方法。　方法:对2例有阴茎背侧溢液史5～6年的 患者进行瘘口探针探查、亚甲蓝注射试验、膀胱镜、B超等辅助检查方法诊断脐尿管未闭异常,予手术切除所有病变 组织及脐尿管。　结果:2例经手术及病理检查均证实为脐尿管交流囊瘘,患者术后随访至今无复发及癌变。　结 论:瘘口探针探查、亚甲蓝注射试验、B超检查为有效的诊断措施;手术应尽可能彻底切除脐尿管及其异常组织。     

脐尿管癌一例报告并文献复习

目的 探讨脐尿管癌的诊断和治疗策略。方法 2019年11月我院收治脐尿管癌患者1例,女性,69岁,完善相关准备后行腹腔镜下扩大性膀胱部分切除及脐尿管和脐切除术。结合国内外文献报道,讨论脐尿管癌的发病特点、诊断要点及治疗策略。结果 术前CT检查示膀胱顶部新生物形成,局部隆起样改变,膀胱镜检查示膀胱顶部肿瘤,活检病理结果提示腺癌。手术顺利,手术时间约3 h,术中出血约20 ml,术后病理结果示中分化腺癌、切缘阴性,术后患者恢复良好。结论 脐尿管癌的诊断依靠临床表现、影像学、膀胱镜检查及免疫组织化学染色,治疗上采用脐、脐尿管及膀胱部分切除术并联合术后化疗。     

黄色肉芽肿性膀胱炎的临床与病理特点分析

目的 探讨黄色肉芽肿性膀胱炎(XC)的临床及病理学特点.方法 XC患者3例.男1例,女2例.年龄37(39,24,50)岁.3例均有反复发作的膀胱刺激征,2例有下腹部疼痛.查体仅1例发现下腹部肿块.2例尿瘤细胞学检查未见瘤细胞,另1例未查.B超、CT示位于膀胱顶部的占位性病变.CT示肿瘤内可见坏死及不均匀强化影像.术前诊断:膀胱肿瘤2例,脐尿管肿瘤1例.2例行膀胱部分切除术,1例行脐尿管癌根治术. 结果 3例术后均经病理证实为XC.病理特点:XC含有大量黄瘤细胞(泡沫细胞)--实质为含有脂质的巨噬细胞,伴有多核巨细胞、淋巴细胞、浆细胞浸润.术后随访12～36个月,平均28个月,患者无明显尿频、尿急等症状,B超或CT检查未见肿物复发.结论 XC临床罕见,不易与其他膀胱疾病鉴别,诊断依赖于病理组织学,同时应警惕其合并肿瘤存在的可能.治疗以手术为主.     

腹腔镜治疗成人脐尿管囊肿3例及文献复习

目的：探讨脐尿管囊肿腹腔镜治疗的技术要点和临床疗效。方法：脐尿管囊肿3例。男2例,女1例,平均48岁,手术切除范围包括脐尿管、脐尿管肿物、脐正中韧带以及与脐尿管肿物相连的部分膀胱顶部;检索PubMed及国内CBM等数据库中相关文献,讨论脐尿管囊肿发病特点、影像学特征以及临床诊治。结果：3例手术均成功,无中转开放手术。平均手术时间121min,3例患者术中均无明显出血,2例术后病理提示脐尿管囊肿,1例提示脐尿管囊肿合并感染。平均留置导尿时间4天,平均住院6天,切口一级愈合,无术后并发症。术后平均随访11个月,无复发,无恶变。结论：腹腔镜手术是治疗脐尿管囊肿的～种微创、安全、有效的方法,即使对于合并感染的脐尿管囊肿也具有同等疗效。     

脐尿管癌临床特点及治疗体会（附6例报告）

目的：探讨脐尿管癌的临床特点,增加对脐尿管癌的了解,提高诊治水平。方法：回顾性分析收治的6例脐尿管癌患者的临床资料：6例患者中,1例行膀胱部分切除术,2例行根治性全膀胱切除术,3例行扩大性膀胱部分切除术。结果：术后随访6个月～3年,1例行膀胱部分切除术患者术后7个月原位复发．再行根治性全膀胱切除术,术后辅以全身化疗。1例行根治性全膀胱切除术患者术后13个月死亡。3例行扩大性膀胱部分切除术患者中,1例术后9个月复发,并与6个月后死亡,其余2例分别随访6个月、18个月未见复发及转移。结论：脐尿管癌是一种少见的膀胱恶性肿瘤,预后差。影像学检查及膀胱镜检查的综合应用是诊断脐尿管癌的主要方法。手术治疗是脐尿管癌的主要治疗方法,扩大性膀胱部分切除术是值得推荐的手术方式。     

彩色多普勒超声在不同类型脐尿管疾病诊断中的价值

目的探讨彩色多普勒超声在诊断不同类型脐尿管疾病中的应用价值。方法分析24例脐尿管疾病患者的超声检查结果及造影、手术和病理结果等临床资料。结果超声诊断脐尿管瘘、脐尿管囊肿、脐尿管憩室的符合率为100％,脐尿管窦的符合率为50％,脐尿管癌的符合率为66．7％。结论彩色超声检查可为脐尿管疾病的诊断和治疗提供有价值的参考。     

腹腔镜下脐尿管间叶组织来源黏液性恶性肿瘤并腹腔内出血手术1例及文献复习

目的提高脐尿管肿瘤的诊治水平,探讨腹腔镜下手术切除脐尿管肿瘤的安全性和可行性。方法回顾性分析1例腹腔镜下脐尿管恶性间叶组织来源的黏液性肿瘤并腹腔内出血手术及术后随访1年患者的病例资料。结合文献总结脐尿管肿瘤的临床特点、诊疗手段、治疗原则。结果本例患者手术顺利,术后1d即下床活动,2d恢复肛门排气,第4天拔除盆腔引流管,术后9d出院。未出现任何并发症。随访10个月无复发。结论膀胱镜检查、彩超、CT、MRI检查是诊断脐尿管肿瘤的必要检查,临床以脐尿管癌报道多见,罕见来源于间叶组织的脐尿管肿瘤的报道,确诊有赖于术后病理检查。腹腔镜手术切除脐尿管肿瘤安全可行、切口美观,符合患者美容方面的需求,值得临床推广应用。     

Pyourachus in spina bifida: case report and review

Failure of the urachus to close results in a multitude of clinical anomalies. Such anomalies have been documented as occurring in association with mechanical bladder outlet obstruction. However, no urachal anomalies have been linked specifically to spina bifida. Two cases of urachal abscesses were identified in adolescent male patients with spina bifida at our institution, both with neuropathic bladders and using self-catheterization. The clinical presentations differed, with classic involvement of the umbilicus in 1 case. Because of its varied presentations, the diagnosis of a urachal anomaly is potentially difficult. Urachal anomalies should be considered in the evaluation of pelvic masses in this demographic.     

Remnants of urachus in infants and children--the problems of diagnosis and treatment

A total of 17 cases of remnants of urachus were examined between 1981 and 1989, including 2 cases of patent urachus, 5 of urachal cyst, 9 of urachal sinus, and 1 of urachal diverticulum. A long urachal sinus was considered to be caused by the self-destruction of a cyst. While patent urachus was diagnosed in neonates with urine discharge from the umbilicus, cysts or sinuses accompanied by infection were more often found in older children. Imaging of the burrows was diagnostic in 8 out of 11 cases, ultrasound examination in 9 out of 12, and CT examination in all of 3 cases. Since this condition is frequently accompanied by malformations of the urinary system, attention must be paid to locating the accompanying anomalies. Although primary extraction was performed in 13 cases, the primary treatment of cases with highly infected cysts should be drainage, followed by secondary extraction. Furthermore, caution must be exercised to avoid hemorrhage in cases with dilation of the umbilical artery.     

La pathologie malformative de l’ouraque: A propos de 12 cas colligés au service de Chirurgie Pédiatrique du CHU Aristide Le Dantec de Dakar,Sénégal

Objectivesto report the epidemiological aspects, diagnosis and treatment of urachal anomalies.Patients and methodsWe conducted a retrospective study in Pediatric Surgery department of Hospital Aristide Le Dantec for a period of 15 years. The parameters studied were the prevalence, sex, age, reason for consultation, clinical, paraclinical, treatment, hospital stay and evolution of urachal anomalies.ResultsWe collected 12 cases of malformative diseases of the urachus, for a prevalence of 0.8 cases/year. Our sample consisted of seven boys and five girls with a sex-ratio of 1.4. The mean age was 1.6 years. We noted a predominance of fistulas of the urachus with 8 cases. Drainage of fluid from the umbilicus was the most common sign in 8 cases. Fistulography was requested for two patients and confirmed the diagnosis of fistula of the urachus. In other cases the diagnosis was made intraoperatively. Surgical treatment was performed in 10 patients and consisted of a laparotomy followed by resection of urachal tissue including a collar of the bladder dome. one case was observed for regression of symptoms. After a mean of 6 months the evolution was marked by the occurrence of an evisceration of infectious origin, three cases of wound infection and two deaths.ConclusionsAnomalies of the urachus are rare in our service. The male is most affected. Drainage of fluid from the umbilicus is the most common sign. Ultrasound should be systematic in the preoperative evaluation and treatment should be surgical.     

Remnants of urachus in infants and children —The problems of diagnosis and treatment—

A total 17 cases of remnants of urachus were examined between 1981 and 1989, including 2 cases of patent urachus, 5 of urachal cyst, 9 of urachal sinus, and 1 of urachal diverticulum. A long urachal sinus was considered to be caused by the self-destruction of a cyst. While patent urachus was diagnosed in neonates with urine discharge from the umbilicus, cysts or sinuses accompanied by infection were more often found in older children. Imaging of the burrows was diagnostic in 8 out of 11 cases, ultrasound examination in 9 out of 12, and CT examination in all of 3 cases. Since this condition is frequently accompanied by malformations of the urinary system, attention must be paid to locating the accompanying anomalies. Although primary extraction was performed in 13 cases, the primary treatment of cases with highly infected cysts should be drainage, followed by secondary extraction. Furthermore, caution must be exercised to avoid hemorrhage in cases with dilation of the umbilical artery.     

Relevance of infection in children with urachal cysts

OBJECTIVE: To assess the role of infection in the management of children with urachal cysts. METHODS: A retrospective study on 10 children with urachal cysts operated on over an 11-year period (from 1987 to 1998) was performed. Uncomplicated urachal cysts were found in 2 children who underwent primary cyst removal. The remaining 8 were admitted with severe sepsis due to the presence of a urachal abscess; they were managed by a staged approach including percutaneous drainage and delayed cyst removal. The diagnosis of urachal cyst was readily made by ultrasound in all the 10 patients (100%). In 1 patient with urachal abscess, computed tomography provided additional information. RESULTS: The postoperative course was uneventful in 9 of 10 children (90%). A 5-year-old female patient developed peritonitis following urachal abscess rupture into the peritoneal cavity, which resulted in additional surgery and prolonged hospitalization. CONCLUSIONS: (1) Ultrasound is an excellent diagnostic tool for patients with urachal cysts. (2) A renal screening ultrasound must be included in the preoperative work-up. (3) A thorough urological assessment is indicated in patients with abnormal renal ultrasound of recurrent urinary infections. (4) At present, a staged surgical procedure still remains the most effective surgical option in children with urachal cyst.     

Urachal anomalies: ultrasonography and management

Background: Fifty-six children with anomalies of the urachus remnant identified by ultrasound scan have been encountered in the authors’ hospital over the last 4 years.Methods Twenty of these 56 cases were symptomatic urachal remnants, whereas the urachus remnants were seen incidentally by ultrasound scanning in the other 36 patients. Symptomatic cases were treated with antibiotics or observation. Then, symptomatic cases were divided into 2 groups. One group, surgical group, was treated with surgical resection of the urachal remnant. The other group, observation group, was followed up without its surgical resection. Forty-four patients, 11 cases of symptomatic urachal remnant and 33 asymptomatic cases, were followed up, excluding patients who had surgical treatment and who were lost to follow-up.Results Thirty patients underwent periodical ultrasonographic examination during follow-up. In 9 cases, including 2 symptomatic cases, urachal remnants have disappeared during the follow-up period spontaneously. No symptom had developed during follow-up from asymptomatic cases.Conclusions The patients with asymptomatic urachal remnants do not require follow-up, and urachal remnants, especially those under 1 year of age, do not require surgical resection unless the patient has multiple episodes.     

Nonoperative management of symptomatic urachal anomalies

Introduction

Symptomatic urachal anomalies are rare disorders that consist of urachal remnants or fistulas with or without an associated cyst. Traditionally, when a urachal anomaly was recognized, operative excision was performed. There has been a shift toward the nonoperative management of urachal anomalies at many centers, although there is little in the literature to support this practice.

Methods

A retrospective chart review of patients with urachal anomalies was performed from January 2002 to March 2008. Children with a draining umbilicus and no radiographic or surgical confirmation of a urachal anomaly were excluded.

Results

Fifteen patients with symptomatic urachal anomalies were identified. The average age was 3.5 years (4 weeks to 14 years). Symptoms included umbilical drainage (n = 10), abdominal pain (n = 6), omphalitis (n = 4), intraabdominal mass (n = 3), dysuria (n = 1), recurrent urinary tract infections (n = 1), and fever (n = 4). The diagnosis was confirmed by ultrasound (n = 13) and/or computed tomographic scan (n = 4). The surgically treated cases included 7 urachal cysts (5 uninfected, 2 infected) and 1 patent urachal fistula. Mean follow-up is 37 months, and there have been no reported recurrences. Those treated without surgical excision included 4 patent urachal fistulas (mean follow-up, 20 months—no recurrences) and 3 infected urachal cysts (percutaneous drainage [n = 2] and laparoscopic drainage [n = 1]—no recurrences on ultrasound at 26 months).

Conclusion

Nonoperative management of urachal anomalies is a reasonable approach and may be extended to infected urachal cysts after initial drainage. Infected cysts that are adequately drained seem to obliterate with time. Modern ultrasonography facilitates thorough follow-up. We propose a treatment algorithm for the management of suspected urachal anomalies.     

腹腔镜下治疗成人脐尿管囊肿的临床分析

目的 探讨腹腔镜下脐尿管囊肿切除术治疗脐尿管囊肿的临床疗效.方法 回顾性分析2011年10月至2015年10月本院5例脐尿管囊肿患者进行腹腔镜下脐尿管囊肿切除术的临床资料及手术结果.结果 5例患者中4例手术获得了成功,其中1例术前具有腹膜炎体征的患者中转为开放手术,术中均无大出血、周围及腹腔脏器损伤等严重并发症;手术时间平均108 min(60～ 150 min),失血量平均约37 mL(20～65 mL),术后住院天数平均8d,2周后均恢复日常活动.4例患者术后病检证实脐尿管囊肿,1例病检回报示脐尿管肉芽肿性炎症,倾向于结核,术后给予抗结核治疗半年;所有患者随访6个月到1年,术后无肉眼血尿、切口感染及囊肿复发、恶变等.结论 腹腔镜下脐尿管囊肿切除术安全有效,可以作为治疗脐尿管囊肿的首选手术方式.对于不伴有脐尿管膀胱瘘者,可不必同时行膀胱袖口切除术.