腹腔镜手术治疗症状性小儿脐尿管囊肿感染及脐尿管脓肿的探索性研究

Exploratory research of laparoscopic surgery in the treatment of symptomatic urachal cyst infection and urachal abscess in children

目的:评价腹腔镜手术治疗症状性小儿脐尿管囊肿感染及脐尿管脓肿的临床疗效及安全性。方法:回顾分析2017年1月至2021年3月采用腹腔镜手术治疗的8例小儿脐尿管囊肿感染及脐尿管脓肿的临床资料。其中男5例,女3例,年龄中位数为6(2.3,10)岁。患儿均有急性感染症状,进行超声、CT检查协助诊断,术前行抗生素输液抗感染治疗,感染症状未能控制。8例患儿均行一期腹腔镜手术切除感染性脐尿管囊肿或脐尿管脓肿,切除囊肿、脐尿管全程及部分膀胱顶壁。结果:本组患儿均顺利完成腹腔镜手术,无中转开放及术中并发症发生,手术时间中位数为137.5(82.5,168)min,出血量中位数为21(10,25)mL,病理均符合诊断。8例患儿术后随访12~62个月,中位36.5(26.8,44.5)个月,无感染、复发、肠梗阻及癌变等发生,排尿均正常。结论:腹腔镜手术一期切除感染性脐尿管囊肿或脐尿管脓肿疗效满意。感染性脐尿管囊肿首先应控制感染,若感染及症状持续存在无好转,可考虑行腹腔镜手术一期切除感染性脐尿管囊肿或脐尿管脓肿。

Objective:To evaluate the efficacy and safety of laparoscopic surgery in the treatment of symptomatic urachal cyst infection and urachal abscess in children.Methods:The clinical data of 8 children with urachal cyst infection and urachal abscess who underwent laparoscopic operation from Jan.2017 to Mar.2021 were retrospectively analyzed.There were 5 males and 3 females,aged from 1 to 10 years,with a median age of 6(2.3,10)years.Eight children had clinical manifestations of acute infection symptoms,the diagnosis was assisted by ultrasound and CT.All children received anti-infection treatment before operation,the infection symptoms could not be controlled.Primary laparoscopic resection of infectious urachal cyst or urachal abscess were performed in 8 children,the cyst,all of the urachus and the bladder wall at the top of the bladder were removed.Results:All children in this group successfully completed laparoscopic surgery without conversion to open surgery and intraoperative complications.The median time of operation was 137.5(82.5,168)min,the median amount of intraoperative bleeding was 21(10,25)mL.The pathology was consistent with the diagnosis.8 patients were followed up for 12 months to 62 months,with the median of 36.5(26.8,44.5)months.No infection,recurrence,i ntestinal obstruction and canceration were found.Urination was normal.Conclusions:The curative effect of laparoscopic primary resection of infectious urachal cyst or urachal abscess is satisfactory.For the infectious urachal cyst,the control of infection should come first.If the infection symptoms persist,laparoscopic surgery can be chosen to remove infectious urachal cyst or urachal abscess in one stage.