Cadeddu J A, Boyle K E, Fabrizio M D, Schulam P G, Kavoussi L R
Department of Urology, University of Texas Southwestern Medical Center, Dallas, 75235-9110, USA.
J Urol. 2000 Nov;164(5):1526-8.
Managing persistent and symptomatic urachal anomalies requires wide surgical excision. Such intervention is recommended to prevent symptom recurrence and complications, most notably malignant degeneration. However, traditional open excision is associated with significant morbidity and prolonged convalescence. We report our experience with the laparoscopic excision of urachal remnants as a less morbid, minimally invasive surgical alternative.
Between October 1993 and December 1999, 4 patients with a mean age of 43.3 years who had a symptomatic urachal cyst underwent laparoscopic radical excision of the urachal remnant. Using 2, 10 mm. and 1 or 2, 5 mm. ports the urachus and medial umbilical ligaments were divided at the umbilicus cephalad to the cyst. The specimen, which included the urachus, cyst and medial umbilical ligaments, was then separated from the bladder dome with or without the bladder cuff and removed intact. We reviewed the perioperative records to assess morbidity, recovery and outcome.
All 4 procedures were completed successfully. No intraoperative or postoperative complications were reported at a mean followup of 15 months (range 2 to 24). Mean operative time was 180 minutes (range 150 to 210) and average hospital stay was 2.75 days (range 1 to 4). Pathological evaluation confirmed a benign urachal remnant in each case. All patients resumed normal activity within 2 weeks.
To minimize the morbidity of radical excision the laparoscopic management of benign urachal remnants in adulthood is efficacious and our preferred method of management.
处理持续性和有症状的脐尿管异常需要广泛的手术切除。推荐进行这种干预以防止症状复发和并发症，最显著的是恶性变。然而，传统的开放切除会导致显著的发病率和延长的康复期。我们报告我们使用腹腔镜切除脐尿管残余物作为一种发病率较低的微创外科替代方法的经验。
在1993年10月至1999年12月期间，4例平均年龄43.3岁、有症状的脐尿管囊肿患者接受了腹腔镜根治性切除脐尿管残余物手术。使用2个10毫米和1个或2个5毫米的端口，在囊肿上方的脐部将脐尿管和脐内侧韧带分开。然后将包括脐尿管、囊肿和脐内侧韧带的标本与膀胱穹隆分离，可带或不带膀胱袖口，并完整切除。我们回顾了围手术期记录以评估发病率、恢复情况和结果。
所有4例手术均成功完成。平均随访15个月（范围2至24个月），未报告术中或术后并发症。平均手术时间为180分钟（范围150至210分钟），平均住院时间为2.75天（范围1至4天）。病理评估证实每例均为良性脐尿管残余物。所有患者在2周内恢复正常活动。
为了将根治性切除的发病率降至最低，腹腔镜处理成年期良性脐尿管残余物是有效的，也是我们首选的处理方法。
