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中華民國泌尿科醫學會雜誌

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篇名 Urachal Anomalies:10-Years’ Experience at Kaohsiung Veterans General Hospital
卷期 13:2
並列篇名 臍尿管發育殘跡案例分析探討:高雄榮總十年來的經驗
作者 黃文宏余家政李瀛輝宋秉洸周春平黃榮慶
頁次 063-066
關鍵字 臍尿管殘跡超音波檢查金黃色葡萄球菌urachal anomaliesultrasonographystaphylococcus aureusTSCI
出刊日期 200206

中文摘要

研究目的:臍尿管是胚胎時期連接膀胱和肚臍之間的通道,若是出生後此通道沒有完全關閉,將因此胚胎時期的殘跡衍伸出許多臨床症狀。我們將回顧近十年來本院治療臍尿管殘跡的經驗。材料與方法:我們回顧自1992年9月至2001年12月,本院30位臍尿管殘跡病患的臨床病歷。我們依據病患的年齡、性別、臍尿管殘跡的類型、疾病的表現、診斷方法、微生物培養、治療方法及預後作分析並討論。結果:臍尿管殘跡的類型包括17位patent urachus,6位urachal cysts,5位urachal sinus,1位urachal diverticulum,1位adenocarcinoma of the urachuspatent。其中有21位男性,9位女性,年齡分從1個月76歲。液體自肚臍滲出是最常見的臨床表現。有25人次接受超音波檢查,10人次接受電腦斷層檢查,4人次接受膀胱鏡檢查,1人次接受靜脈顯影劑腎盂攝影。超音波檢查對於patent urachus有76%正確診斷率,對於urachal cyst有100%正確診斷率。金黃色葡萄球菌是最常見的致感染菌種。有21位病患接受立即的手術切除,7位接受初步抗生素治療及後續手術切除,1位接受初步抗生素治療及後續手術切開引流,1位拉受根除性膀胱切除及迴腸導管尿液分流。結論:根據本院的經驗,在臍尿管殘跡的類型中,以patent urachus最常見,並且常發生在新生兒,較少見於成人。臍尿管殘跡較好發在男性。此外,當我們懷疑病患是臍尿管殘跡病例時,超音波可以作為檢查臍尿管異常的理想工具。

英文摘要

OBJECTIVE: Persistence of all or a portion of the embryonic tract between the urinary bladder and the umbilicus results in a variety of urachal anomalies. We reviewed our experience in treating urachal anomalies during a 10-year period. MATERIALS AND METHODS: Medical records of 30 patients with urachal anomalies treated at our hospital from September 1992 to December 2001 were retrospectively reviewed. Data were analyzed according to the age, gender, type of each urachal remnant, presentations of the disease, evaluation methods, bacteriology, treatment and outcomes. RESULTS: The variants of urachal anomalies included a patent urachus in 17 patients, urachal cysts in 6, urachal sinus in 5, urachal diverticulum in 1, and an adenocarcinoma of the urachus in 1. The study population consisted of 21 males and 9 females ranging in age from 1 month to 76 yeas. Discharge from the umbilicus was the most common manifestation. Diagnostic modalities included ultrasonography in 25 cases, computed tomography in 10 cases, cystoscopy in 4cases, and intravenous phelography in 1 case. Correct diagnosis by ultrasonography was made in 76% of cases with a patent urachus and 100%of cases with urachal cysts. Staphylococcus aureus was the predominant microorganism cultured. Treatment involved primary excision of the urachus in 21 cases, antibiotics treatment followed by delayed excision in 7 cases, antibiotics treatment with open drainage in 1 case, and radical cystectomy with ileal conduit in the case with the urachal adenocarcinoma. CONCLUSIONS: Based on our experience, among variants of urachal anomalies, a patent urachus was the most common anatomic presentation seen at birth and in early infancy but was a less-common presentation in adults. Urachal anomalies are more common in males. Moreover, ultrasonography is ideally suitable for demonstrating urachal anomalies.