Sato Hideaki, Furuta Shigeyuki, Tsuji Shiho, Kawase Hirokazu, Kitagawa Hiroaki
Department of Pediatric Surgery, St. Marianna University Yokohama City Seibu Hospital, 1197-1, Yasashi-cho, Asahi-ku, Yokohama, Kanagawa, 241-0811, Japan,
Pediatr Surg Int. 2015 Jun;31(6):581-7. doi: 10.1007/s00383-015-3712-1. Epub 2015 Apr 21.
Optimal therapy for urachal remnant (UR) in children is controversial. Nonoperative management for symptomatic UR is an alternative. Many papers support the laparoscopic approach but the indication for this is unclear. We review our experience to determine the optimal management of UR.
A retrospective chart review of patients from 1990 to 2013 with UR was performed. Patients were analyzed according to age, gender, initial symptoms, type of UR, treatment, and outcome.
We identified 27 patients (M:F = 17:10). A urachal sinus was found in 16 cases (59%), a urachal cyst in 5 (18%) and a urachal duct in 6 (22%). Eleven (A) were under 1 year, with 16 over 1 year (B). In Group A, the commonest symptom was umbilical granulation (n = 6, 54%). Group B was dominated by abdominal pain (n = 12, 75%). Six cases in Group A needed operation for repeated infections. In 5 cases, the UR disappeared. In Group B, 2 cases were followed conservatively. The others required surgery. From 2009, we utilized a laparoscopic approach (LA, n = 7) rather than the classical umbilical approach (UA, n = 13). The operation time was not significantly different (LA = 124 min: UA = 110 min, P > 0.05). There was a tendency for shorter hospital stay following LA (LA = 7.5 days: UA = 10.9 days). Complete resection was always possible using UA in Group A but a more caudal incision (mean 3.6 cm) was required in group B. LA enabled confirmation of the complete resection with three 5 mm ports in Group B. There were no operative complications after LA against two wound infections, one of which suffered a disruption, after UA.
Conservative follow-up is recommended for UR under 1-year old except when there are repeated infections. The umbilical approach is enough for infants. Laparoscopic surgery is recommended in older children.
儿童脐尿管残余物（UR）的最佳治疗方法存在争议。对有症状的UR进行非手术治疗是一种选择。许多文献支持腹腔镜手术方法，但该方法的适应症尚不清楚。我们回顾我们的经验以确定UR的最佳治疗方法。
对1990年至2013年患有UR的患者进行回顾性病历审查。根据年龄、性别、初始症状、UR类型、治疗方法和结果对患者进行分析。
我们确定了27例患者（男：女 = 17：10）。发现脐尿管窦16例（59%），脐尿管囊肿5例（18%），脐尿管瘘6例（22%）。11例（A组）年龄在1岁以下，16例（B组）年龄超过1岁。A组最常见的症状是脐部肉芽（n = 6，54%）。B组以腹痛为主（n = 12，75%）。A组6例因反复感染需要手术。5例中，UR消失。B组2例进行保守随访。其他患者需要手术。从2009年起，我们采用腹腔镜手术方法（LA，n = 7）而非传统的脐部手术方法（UA，n = 13）。手术时间无显著差异（LA = 124分钟：UA = 110分钟，P > 0.05）。LA术后住院时间有缩短趋势（LA = 7.5天：UA = 10.9天）。A组使用UA总能实现完全切除，但B组需要更靠下的切口（平均3.6厘米）。LA通过B组的三个5毫米切口能够确认完全切除。LA术后无手术并发症，而UA术后有两例伤口感染，其中一例伤口裂开。
1岁以下的UR，除非有反复感染，建议进行保守随访。脐部手术方法对婴儿足够。大龄儿童建议采用腹腔镜手术。
