McCollum M O, Macneily A E, Blair G K
Division of Pediatric Surgery and Pediatric Urology, British Columbia's Children's Hospital, Vancouver, British Columbia, Canada.
J Pediatr Surg. 2003 May;38(5):798-803. doi: 10.1016/jpsu.2003.50170.
BACKGROUND/PURPOSE: The abdominal manifestations of urachal remnants often prompt referral to the pediatric general surgeon. The purpose of this study was to evaluate the authors' management of this anomaly.
The authors performed a retrospective review of patients presenting to their institution with urachal remnants between 1984 and 2001. Clinical and radiographic details of presentation, management, and outcomes are described.
Twenty-six patients presented at a median age of 4 years (range, 2 days to 12 years), 16 were boys, and 18 required inpatient care. Eleven (42%) presented with infection, 7 (27%) with clear drainage, 3 (12%) with umbilical polyps/granulation, 3 (12%) with pain, one (4%) with recurrent urinary tract infections, and one (4%) with an asymptomatic punctum. One had an associated anomaly (hypospadias). Urinalysis and urine cultures did not correlate with infection. Ultrasound scan was diagnostic in greater than 90% of cases. Overall, 20 patients underwent primary cyst excision, and 6 underwent incision and drainage (I&D) with delayed excision. Five patients underwent primary excision while infected, and 2 had postoperative complications (wound infection and urine leak). All 6 patients who underwent 2-stage procedure initially presented with infection, and none had complications.
Persistent urachal remnants can present at any age with a variety of clinical manifestations. Ultrasound scan is a reliable diagnostic tool. Additional diagnostic studies generally are not warranted. Simple excision of noninfected lesions is appropriate. In cases of acute infection, initial I&D with delayed cyst excision may be preferable to avoid unnecessary complications.
背景/目的：脐尿管残余的腹部表现常促使患者转诊至小儿普通外科医生处。本研究的目的是评估作者对这种异常情况的处理方法。
作者对1984年至2001年间在其机构就诊的脐尿管残余患者进行了回顾性研究。描述了临床表现、影像学细节、处理方法及结果。
26例患者就诊时的中位年龄为4岁（范围为2天至12岁），其中16例为男孩，18例需要住院治疗。11例（42%）表现为感染，7例（27%）有清亮引流液，3例（12%）有脐息肉/肉芽组织，3例（12%）有疼痛，1例（4%）有复发性尿路感染，1例（4%）有无症状小孔。1例有相关畸形（尿道下裂）。尿液分析和尿培养结果与感染情况不相关。超声检查在超过90%的病例中具有诊断价值。总体而言，20例患者接受了一期囊肿切除，6例接受了切开引流（I&D）并延期切除。5例患者在感染时接受了一期切除，2例有术后并发症（伤口感染和尿液渗漏）。所有6例接受两阶段手术的患者最初均表现为感染，且均无并发症。
持续性脐尿管残余可在任何年龄出现，有多种临床表现。超声检查是一种可靠的诊断工具。一般无需进行额外的诊断性检查。对未感染的病变进行简单切除是合适的。在急性感染的情况下，最初进行切开引流并延期囊肿切除可能更可取，以避免不必要的并发症。
