Beasley Spencer W
Department of Paediatric Surgery, Christchurch Hospital, Christchurch, New Zealand.
J Paediatr Child Health. 2017 Nov;53(11):1123-1126. doi: 10.1111/jpc.13760.
The umbilicus is involved in a wide range of abnormalities in infants and children. The most severe are evident at birth and include exomphalos (omphalocele) and gastroschisis, both of which can be life-threatening but are easy to diagnose. Exomphalos is often associated with other congenital abnormalities, whereas the associated problems in gastroschisis are largely confined to the gut. Infection of the umbilicus in the neonate presents as omphalitis. The causes of a moist umbilicus following separation of the umbilical stump are multiple, from the relatively minor umbilical granuloma or ectopic bowel mucosa to the more significant patent urachus that leaks urine. Patency of the entire vitello-intestinal (omphalomesenteric) tract allows air and faecal fluid to drain through the umbilicus. The clinical manifestations of persistence of the vitello-intestinal tract vary markedly according to which part remains: clinical presentations include melaena and anaemia, closed-loop bowel obstruction and Meckel diverticulitis. An umbilical hernia occurs when the umbilical cicatrix fails to close. On the other hand, the umbilicus has its uses, which range from being a route for intravenous access in the neonate to being a convenient point of access in laparoscopic surgery.
脐部涉及婴幼儿的多种异常情况。最严重的在出生时就很明显，包括脐膨出和腹裂，这两种情况都可能危及生命，但易于诊断。脐膨出常与其他先天性异常相关，而腹裂的相关问题主要局限于肠道。新生儿脐部感染表现为脐炎。脐残端分离后脐部潮湿的原因多种多样，从相对轻微的脐肉芽肿或异位肠黏膜到更严重的漏尿的脐尿管未闭。整个卵黄管（脐肠系膜管）通畅会使空气和粪便液体通过脐部排出。卵黄管持续存在的临床表现根据残留部分的不同而有显著差异：临床表现包括黑便和贫血、闭袢性肠梗阻以及梅克尔憩室炎。当脐瘢痕未能闭合时会发生脐疝。另一方面，脐部也有其用途，从作为新生儿静脉通路的途径到作为腹腔镜手术方便的进入点。
