Division of Urology, Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Pediatric Urology, LeBonheur Children's Hospital, Department of Urology, University of Tennessee, Memphis, Tennessee (JMG).
Division of Urology, Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Pediatric Urology, LeBonheur Children's Hospital, Department of Urology, University of Tennessee, Memphis, Tennessee (JMG).
J Urol. 2015 Feb;193(2):632-6. doi: 10.1016/j.juro.2014.09.004. Epub 2014 Sep 16.
We examined the presentation, diagnosis and management of radiologically detected pediatric urachal anomalies and assessed the risk of malignant degeneration.
Our radiology database (2000 to 2012) was queried for all children younger than 18 years who were diagnosed with a urachal anomaly radiographically, and the operative database was used to determine those who underwent excision. Data collected included demographics, presenting symptoms, imaging modality and indication for excision. These data were compared to the Ontario Cancer Registry to determine the risk of malignancy.
A total of 721 patients were radiographically diagnosed with a urachal anomaly (667 incidentally), yielding a prevalence of 1.03% of the general pediatric population. Diagnoses were urachal remnants (89% of cases), urachal cysts (9%) and patent urachus (1.5%). Ultrasonography was the most common imaging modality (92% of cases), followed by fluoroscopy/voiding cystourethrography (5%) and computerized tomography/magnetic resonance imaging (3%). A total of 61 patients (8.3%) underwent surgical excision. Indications for imaging and treatment were umbilical drainage (43% of patients), abdominal pain (28%), palpable mass (25%) and urinary tract infection (7%). Mean age at excision was 5.6 years and 64% of the patients were male. Based on provincial data, the number needed to be excised to prevent a single case of urachal adenocarcinoma was 5,721.
Urachal anomalies are more common than previously reported. Children with asymptomatic lesions do not appear to benefit from prophylactic excision, as the risk of malignancy later in life is remote and a large number of urachal anomalies would need to be removed to prevent a single case of urachal adenocarcinoma.
我们研究了放射学检测到的小儿脐尿管异常的表现、诊断和处理方法，并评估了恶性转化的风险。
我们对 2000 年至 2012 年所有年龄小于 18 岁的经放射学诊断为脐尿管异常的患儿的放射学数据库进行了检索，并使用手术数据库来确定接受切除术的患儿。收集的数据包括人口统计学资料、临床表现、影像学检查方法和切除的适应证。我们将这些数据与安大略癌症登记处的数据进行比较，以确定恶性肿瘤的风险。
共有 721 例患儿经放射学诊断为脐尿管异常（667 例为偶然发现），普通儿科人群中的患病率为 1.03%。诊断结果为脐尿管残迹（占 89%的病例）、脐尿管囊肿（9%）和开放型脐尿管（1.5%）。超声检查是最常见的影像学检查方法（92%的病例），其次是透视/排尿性膀胱尿道造影（5%）和计算机断层扫描/磁共振成像（3%）。共有 61 例患儿（8.3%）接受了手术切除。影像学检查和治疗的适应证为脐部引流（43%的患者）、腹痛（28%）、可触及的肿块（25%）和尿路感染（7%）。切除时的平均年龄为 5.6 岁，64%的患儿为男性。根据省级数据，为预防单个脐尿管腺癌病例发生，需要切除的病例数为 5721 例。
脐尿管异常比之前报道的更为常见。无症状病变的患儿似乎不需要预防性切除，因为其日后发生恶性肿瘤的风险较低，需要切除大量的脐尿管异常才能预防单个脐尿管腺癌病例的发生。
Zotero 插件