Tian Jun, Ma Jian-Hui, Li Chang-Ling, Xiao Zhen-Dong
Department of Urology, Cancer Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Zhonghua Yi Xue Za Zhi. 2008 Mar 25;88(12):820-2.
To summarize the experience in diagnosis and treatment of urachal mass in adults.
The clinical data of 33 patients with urachal mass, 21 male and 12 females, aged 49 (30-75), were analyzed retrospectively.
The urachal masses of 11 patients (33%, 11/33) were benign, including 5 cases of abscess, 3 of cyst, 2 of malacoplakia, and 1 of xanthogranuloma. The most common symptom of the benign urachal mass was abdominal mass (36%). Seven patients underwent computed tomography (CT) and no calcification was found. All 11 patients were treated successfully by mass excision. Twenty-two cases (67%) had urachal carcinomas, including 17 cases of adenocarcinoma, 4 of squamous carcinoma, and 1 of transitional cell carcinoma. The most common symptom was gross hematuria (68%) in the malignant urachal mass patients and CT showed calcification in 38% of them (5/13). The overall 5-year cancer-specific survival rate was 45.2%. Nine patients with localized cancer underwent extended partial cystectomy with a 5-year cancer-specific survival rate of 78.3%. The patients with metastatic urachal cancer underwent multimodal treatment with an objective response rate of 50% for chemotherapy and 25% for radiation therapy. The median survival time after metastasis of the 8 cases given multimodal treatment was 14.0 months, 7.5 months longer than that of the 4 cases untreated (6.5 months, P = 0.09).
The majority of urachal mass in adults is malignant. CT helps in distinguishing the benignancy from malignancy of urachal mass. Surgical excision affords good course for benign urachal mass. Extended partial cystectomy provides a curative surgical treatment for localized urachal cancer. The prognosis of metastatic urachal cancer is poor. Active multimodal treatment may improve the survival of patients with metastatic disease.
总结成人脐尿管肿物的诊治经验。
回顾性分析33例脐尿管肿物患者的临床资料，其中男性21例，女性12例，年龄49岁（30 - 75岁）。
11例患者（33%，11/33）的脐尿管肿物为良性，包括5例脓肿、3例囊肿、2例软斑病和1例黄色肉芽肿。良性脐尿管肿物最常见的症状是腹部肿块（36%）。7例患者接受了计算机断层扫描（CT）检查，未发现钙化。所有11例患者均通过肿物切除术成功治愈。22例（67%）为脐尿管癌，包括17例腺癌、4例鳞癌和1例移行细胞癌。恶性脐尿管肿物患者最常见的症状是肉眼血尿（68%），CT显示其中38%（5/13）有钙化。总体5年癌症特异性生存率为45.2%。9例局限性癌症患者接受了扩大性部分膀胱切除术，5年癌症特异性生存率为78.3%。转移性脐尿管癌患者接受了多模式治疗，化疗的客观缓解率为50%，放疗为25%。接受多模式治疗的8例患者转移后的中位生存时间为14.0个月，比4例未治疗患者的生存时间（6.5个月）长7.5个月（P = 0.09）。
成人脐尿管肿物多数为恶性。CT有助于区分脐尿管肿物的良恶性。手术切除对良性脐尿管肿物疗效良好。扩大性部分膀胱切除术为局限性脐尿管癌提供了根治性手术治疗。转移性脐尿管癌的预后较差。积极的多模式治疗可能改善转移性疾病患者的生存。
