Yoo Koo Han, Lee Sun-Ju, Chang Sung-Goo
Department of Urology, Kyunghee University, Dongdaemun-gu, Seoul 130-702, Korea.
Yonsei Med J. 2006 Jun 30;47(3):423-7. doi: 10.3349/ymj.2006.47.3.423.
The urachus is a fibrous cord that arises from the anterior bladder wall and extends cranially to the umbilicus. Traditionally, infection has been treated using a two-stage procedure that includes an initial incision and drainage which is then followed by elective excision. More recently, it has been suggested that a single-stage excision with improved antibiotics is a safe option. Thus, we intended to compare the effects of the two-stage procedure and the single-stage excision. We performed a retrospective review on nine patients treated between May 1990 and September 2005. The methods used in diagnosis were ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and cystoscopy. The study group was comprised of three males and six females with a mean age of 28.2 years (with a range from three to 71 years). Symptoms consisted of abdominal pain, abdominal mass, fever, and dysuria. The primary incision and drainage followed by a urachal remnant excision with a bladder cuff excision (two-stage procedure) was performed in four patients. The mean postoperative hospitalization lasted 5.8 days (with a range of three to seven days), and there were no reported complications. A primary excision of the infected urachal cyst and bladder cuff (single-stage excision) was performed in the other five patients. These patients had a mean postoperative hospitalization time of 9.2 days (with a range of four to 15 days), and complications included an enterocutaneous fistula, which required additional operative treatment. The best method of treating an infected urachal cyst remains a matter of debate. However, based on our results, the two-stage procedure is associated with a shorter hospital stay and no complications. Thus, when infection is extensive and severe, we suggest that the two-stage procedure offers a more effective treatment option.
脐尿管是一条纤维索，起自膀胱前壁，向头侧延伸至脐部。传统上，感染采用两阶段手术治疗，包括初始切开引流，随后进行择期切除。最近，有人提出使用改进的抗生素进行单阶段切除是一种安全的选择。因此，我们旨在比较两阶段手术和单阶段切除的效果。我们对1990年5月至2005年9月期间治疗的9例患者进行了回顾性研究。诊断方法包括超声、计算机断层扫描（CT）、磁共振成像（MRI）和膀胱镜检查。研究组包括3名男性和6名女性，平均年龄28.2岁（范围为3至71岁）。症状包括腹痛、腹部肿块、发热和排尿困难。4例患者采用了先进行切开引流，随后切除脐尿管残余并切除膀胱袖口（两阶段手术）。术后平均住院时间为5.8天（范围为3至7天），未报告并发症。另外5例患者进行了感染性脐尿管囊肿和膀胱袖口的一期切除（单阶段切除）。这些患者术后平均住院时间为9.2天（范围为4至15天），并发症包括肠皮肤瘘，需要额外的手术治疗。治疗感染性脐尿管囊肿的最佳方法仍存在争议。然而，根据我们的结果，两阶段手术住院时间较短且无并发症。因此，当感染广泛且严重时，我们建议两阶段手术提供了一种更有效的治疗选择。
