Clinical experience of laparoscopic entire resection of urachus for treating urachal fistula
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摘要: 目的：探讨腹腔镜下脐尿管全段切除术治疗脐尿管瘘（UF）的技术要点和临床疗效。方法：2013年6月~2018年1月对我院收治的7例UF患者施行腹腔镜下脐尿管全段切除术，术前7例患者均行彩超检查和CT平扫三维成像发现，3例行脐尿管造影检查证实。术中沿脐上弧形切口进入分离脐尿管脐部，置入3个trocar，术中采用超声刀切开下腹正中襞，向下方游离脐尿管至膀胱顶部，自脐部至膀胱连接处整块切除脐尿管全段及部分膀胱壁，可吸收线连续缝合关闭膀胱裂口。7例均经手术探查及病理学结果证实。结果：7例均顺利完成腹腔镜手术，无中转开放。手术时间45~70 min，平均55 min；术中出血10~20 ml，平均15 ml；术后住院3~5 d，平均4 d；7例随访4~55个月，未发现感染、复发及癌变。结论：腹腔镜下脐尿管整块切除术治疗UF安全有效，具有手术时间短、康复快、出血量少、腹部美观、治疗效率高等优点。Abstract: Objective: To discuss the technique and clinical efficacy of laparoscopic entire resection of urachus for treating urachal fistula. Method: Between June 2013 and January 2018, 7 patients with urachal fistula received entire resection of the urachus in our hospital by laparoscopy with three trocar technique. Preoperative ultrasound examination and three-dimensional CT scanning were performed in all 7 patients, and 3 cases were confirmed by urachal radiography. The urachus was cut by ultrasonic scalpel, and then the entire urachus was clipped extending from the the umbilicus to the urinary bladder and part of top wall of urinary bladder. The urinary bladder was closed by resorbable suture. All seven cases were confirmed by surgical exploration and pathological results. Result: All the operations were completed under laparoscope without conversion to open surgery. The operation time ranged from 45 to 70 minutes (mean, 55 minutes). The intraoperative blood loss was 10 to 20 ml (mean, 15 ml). The patients were discharged form hospital 3 to 5 days after the operation (mean, 4 days). Among our cases, 7 achieved a mean of 28.6 months follow-up (4 to 55 months), during this period none of them developed infection, recurrence or carcinomatous change.Conclusion: Laparoscopic entire resection of urachus is feasible for urachal fistula. The method is simple and minimal invasive with good cosmetic outcomes and results in quick recovery.
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Key words:
- laparoscopy /
- resection of urachus /
- urachal fistula
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