儿童脐尿管残存的腹腔镜手术治疗

Laparoscopic management of urachal remnants in children

目的探讨腹腔镜技术在儿童脐尿管残存的手术治疗中的应用及有效性。方法回顾性分析2012年5月至2018年4月在浙江大学医学院附属儿童医院泌尿外科应用腹腔镜技术治疗的15例脐尿管残存患儿的临床资料。对其性别、发病年龄、初发症状、诊断方法、影像学发现、腔镜治疗情况、治疗转归、术后并发症和病理结果进行分析。结果本组15例中,女5例,男10例;脐尿管囊肿11例,脐尿管瘘4例;手术年龄3个月至11岁8个月,中位年龄4岁6个月。其中11例行腹腔镜下脐尿管切除术,手术方式均保留脐部;有2例因脐尿管残存与膀胱相连紧密,切除部分膀胱浆膜层,并予以膀胱修补。另4例因术中发现脐尿管囊肿周围炎症粘连明显而中转开放,有2例行膀胱浆膜层部分切除予以修补。本组术后均予广谱抗生素预防感染,术后病理检查均证实符合脐尿管残存。所有患儿随访3个月至5年,无再发感染及囊肿复发病例。结论腹腔镜技术治疗脐尿管残存安全有效,保留脐部更能改善外观。选择性行膀胱部分切除能缩短术后恢复期,伴感染时应先行抗感染治疗,再择期手术。

Objective To evaluate the efficacy and approach of laparoscopic excision of urachal remnants in children.Methods From May 2012 to April 2018,retrospective reviews were conducted for medical records of all children undergoing laparoscopic excision of urachal remnants.Results There were 10 boys and 5 girls with a median age of 4.5(0.3-16.8)years.Umbilicus-sparing laparoscopic urachal excision was performed.The causes were urachal cyst(n=11)and patent urachus(n=4).Complete excision(n=11)and conversion into open surgery&partial cystectomy(n=4)were performed.Postoperative antibiotics were offered.All diagnoses were confirmed by pathological examinations.During a follow-up period of 3-60 months,there was no onset of re-infection or cyst recurrence.Conclusions Umbilicus-sparing laparoscopy is both safe and effective for treating persistent or infected urachus.It offers superior cosmetic outcomes.Partial cystectomy depends upon the presence of an adherent communicating urachal cyst attached to bladder dome.For acute infection,antibiotic dosing or initial incision&drainage with delayed cyst excision may be adopted for avoiding unnecessary complications.