Патология урахуса: обзор литературы, современные аспекты хирургического пособия и собственный клинический опыт лапароскопического лечения

Гусев А.А., Яцык С.П., Киргизов И.В. и др. Патология урахуса: обзор литературы, современные аспекты хирургического пособия и собственный клинический опыт лапароскопического лечения. Педиатрия (Прил. к журн. Consilium Medicum). 2018; 3: 80–84.
DOI: 10.26442/2413-8460_2018.3.80-84

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Gusev A.A., Yacyk S.P., Kirgizov I.V. et al. Urachus pathology: literature review, modern aspects of the surgical manual and own clinical experience of laparoscopic treatment. Pediatrics (Suppl. Consilium Medicum). 2018; 3: 80–84.
DOI: 10.26442/2413-8460_2018.3.80-84

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Аннотация

Патологии урахуса чаще всего диагностируются у новорожденных, и частота встречаемости довольно высока (по некоторым данным до 30–50% новорожденных имеет ту или иную патологию урахуса). Несмотря на стремительное развитие лапароскопических технологий и довольно высокую частоту встречаемости патологии урахуса, в современных литературных источниках имеется крайне мало материалов по данной тематике, что показывает востребованность и своевременность нашего обзора. Пороки развития урахуса подразделяются на 4 типа в зависимости от степени незаращения: пупочный свищ; киста урахуса; пузырно-пупочный свищ; дивертикул мочевого пузыря. Консервативная терапия при пороках развития урахуса возможна только при наличии пупочного свища (синуса). Во всех остальных случаях, а также в случаях неэффективности консервативной терапии, проводится хирургическое лечение. Операцией выбора как при неосложненной, так и при нагноившейся кисте следует считать ее радикальное иссечение вместе с мочевым протоком. Малоинвазивное оперативное лечение также необходимо считать вариантом выбора при данной патологии, так как при лапароскопическом доступе значительно снижаются объем травматизации тканей, длительность болевого синдрома в послеоперационном периоде и время пребывания ребенка в стационаре, качественно улучшается косметический результат хирургического лечения.
Ключевые слова: киста урахуса, свищ пупка, пупочный синус, пузырно-пупочный свищ, дивертикул мочевого пузыря, лапароскопия, лапароскопическое лечение кист урахуса, пороки развития урахуса, детская хирургия, клинический опыт, малоинвазивные операции.

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Urachus pathologies are most often diagnosed in newborns, and the frequency of occurrence is rather high (according to some data up to 30–50% of new-borns have this or that pathology of urahus). Despite the rapid development of laparoscopic technologies and a rather high incidence of pathology Urakhus, in modern literary sources there is very little material on this subject, which shows the relevance and timeliness of our review. Malformations of development of urachus are subdivided into 4 types depending on the degree of non-spreading: umbilical fistula; urachus cyst; bladder-navel fistula; diverticulum of the bladder. Conservative therapy for malformations of urachus is possible only if there is an umbilical fistula (sinus). In all other cases, as well as in cases of ineffective conservative therapy, surgical treatment is performed. The operation of choice for both uncomplicated and festering cysts should be considered as a radical excision along with the urinary duct. Low invasive surgical treatment should also be considered as a choice option for this pathology, as with laparoscopic access, the volume of tissue trauma, the duration of the pain syndrome in the postoperative period and the time of the child's stay in the hospital are significantly reduced, and the cosmetic result of surgical treatment qualitatively improves.
Key words: urachus cyst, navel fistula, umbilical sinus, bladder-umbilical fistula, bladder diverticulum, laparoscopy, laparoscopic treatment of urachus cysts, developmental defects of urachus, pediatric surgery, clinical experience, little invasive operations.

Список литературы

1. Araki M, Saika T, Araki D et al. Laparoscopic management of complicated urachal remnants in adult. World J Urol 2012; 30: 647–50.
2. Ashley R, Inman B, Routh J et al. Urachal anomalies: a longitudinal study of urachalremnants in children and adults. J Urol 2007; 178: 1615–8.
3. Berman SM, Tolia BM, Laor E. Urachal remnants in adults. Urology 1988; 31: 17–21.
4. Campbell Begg R. The Urachus: its anatomy, histology and development. J Anat 1930; 64: 170–83.
5. Castanheira de Oliveira M, Vila F, Versos R et al. Laparoscopic treatment of urachal remnants. Actas Urol Esp 2012; 36: 320–4.
6. Castillo OA, Vitagliano G, Olivares R, Sanchez-Salas R. Complete excision of urachal cyst by laparoscopic means: a new approach to an uncommon disorder. Arch Esp Urol 2007; 60: 607–11.
7. Cutting CW, Hindley RG. Laparoscopic management of complicated urachal remnants. BJU int 2005; 96: 1417–21.
8. Ekwueme KC, Parr NJ. Infected urachal cyst in an adult: a case report and review of the literature. Cases J 2009; 2: 6422.
9. Flanagan DA, Mellinger JD. Urachal-sigmoid fistula in an adult male. Am Surg 1998; 64: 762–3.
10. Fode M, Pedersen GL, Azawi N. Symptomatic urachal remnants: Case series with results of a robot-assisted laparoscopic approach with primary umbilicoplasty. Scand J Urol 2016; 50 (6): 463–7.
11. Gopalan A, Sharp DS, Fine SW et al. Urachal carcinoma: a clinicopathologic analysis of 24 cases with outcome correlation. Am J Surg Pathol 2009; 33: 659–68.
12. Huang C, Luo C, Chao H et al. Urachal anomalies in children: experience at one institution. Chang Gung Med J 2003; 26: 412–6.
13. Joung HJ, Han DY, Kwon WA. Laparoscopic Management of Complicated Urachal Remnants. Chonnam Med J 2013; 49: 43–7.
14. Kim D, Lee J, Park S et al. Initial experience with robotic-assisted laparoscopic partial cystectomy in urachal diseases. Korean J Urol 2010; 51: 318–22.
15. Kumar K, Mehenna D. Injury of urachal diverticulum due to laparoscope port: f case report, literature review and recommendations. J Med Cases 2015; 6 (1): 1–5.
16. Little D, Shah S, St Peter S et al. Urachal anomalies in children: the vanishing relevance of the preoperative voiding cystourethrogram. J Pediatr Surg 2005; 40: 1874–6.
17. Mazzucchelli R, Scarpelli M, Montironi R. Mucinous adenocarcinoma with superficial stromal invasion and villous adenoma of urachal remnants: a case report. J Clin Pathol 2003; 56: 465–7.
18. Moore KL. The developing human: Сlinically oriented embryology. 2nd ed. Philadelfhia: WB Saunders Company, 1977; 307–9.
19. Patrzyk M, Glitsch A, Schreiber A et al. Single-incision laparoscopic surgery as an option for the laparoscopic resection of an urachal fistula: first description of the surgical technique. Surg Endosc 2010; 24: 2339–42.
20. Pedro PJ, Edgar V, Carlos R, Amilcar S. Urachal abscess clinically mimicking a malignancy. Clin Exp Pathol 2012; 4 (1): 154.
21. Rapoport D, Alison R, Goshko V et al. Urachal-Sigmoid Fistula Associated with Diverticular Disease. Canadian Urol Association J 2007; 1: 52–4.
22. Trondsen E, Reiertsen O, Rosseland A. Laparoscopic excision of urachal sinus. Eur J Surg 1993; 159: 127–8.
23. Whitehead A, Arthur LG, Prasad R. Laparoscopic vs Open Excision of Urachal Remnants in Children. J Surgery 2015; 2 (2): 3.
24. Widni EE, Höllwarth ME, Haxhija EQ. The impact of preoperative ultrasound on correct diagnosis of urachal remnants in children. J Pediatr Surg 2010; 45: 1433–7.
25. Yalawar RS, Khanapur R, Patil LS et al. Infected urachal sinus presenting as infraumbilical mass: A Case report and review of literature. IOSR J Dental Med Sci 2014; 13 (8): 12–5.
26. Yiee JH, Garcia N, Baker LA et al. A diagnostic algorithm for urachal anomalies. J Pediatr Urol 2007; 3: 500–4.
27. Корейба К.А. Осложненное течение кисты урахуса. Казанский мед. журн. 2007; 88 (3): 277–8. / Koreiba K.A. Oslozhnennoe techenie kisty urahusa. Kazanskij med. zhurn. 2007; 88 (3): 277–8. [in Russian]
28. Кущ Н.Л., Пугачев А.Г., Москаленко В.З. Хирургия пороков почек и мочевых путей у детей. Киев: Здоров’я, 1978. / Kush N.L., Pugachev A.G., Moskalenko V.Z. Hirurgiya porokov pochek i mochevyh putej u detej. Kiev: Zdorov’ya, 1978. [in Russian]
29. Ольшанецкий А.А., Новоскольцева И.Г., Левина В.П. и др. Нагноение кисты урахуса. Хірургія України. 2014; 2: 121–4. / Ol'shanetskii A.A., Novoskol'tseva I.G., Levina V.P. i dr. Nagnoenie kisty urakhusa. Khіrurgіia Ukraini. 2014; 2: 121–4. [in Russian]

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1. Araki M, Saika T, Araki D et al. Laparoscopic management of complicated urachal remnants in adult. World J Urol 2012; 30: 647–50.
2. Ashley R, Inman B, Routh J et al. Urachal anomalies: a longitudinal study of urachalremnants in children and adults. J Urol 2007; 178: 1615–8.
3. Berman SM, Tolia BM, Laor E. Urachal remnants in adults. Urology 1988; 31: 17–21.
4. Campbell Begg R. The Urachus: its anatomy, histology and development. J Anat 1930; 64: 170–83.
5. Castanheira de Oliveira M, Vila F, Versos R et al. Laparoscopic treatment of urachal remnants. Actas Urol Esp 2012; 36: 320–4.
6. Castillo OA, Vitagliano G, Olivares R, Sanchez-Salas R. Complete excision of urachal cyst by laparoscopic means: a new approach to an uncommon disorder. Arch Esp Urol 2007; 60: 607–11.
7. Cutting CW, Hindley RG. Laparoscopic management of complicated urachal remnants. BJU int 2005; 96: 1417–21.
8. Ekwueme KC, Parr NJ. Infected urachal cyst in an adult: a case report and review of the literature. Cases J 2009; 2: 6422.
9. Flanagan DA, Mellinger JD. Urachal-sigmoid fistula in an adult male. Am Surg 1998; 64: 762–3.
10. Fode M, Pedersen GL, Azawi N. Symptomatic urachal remnants: Case series with results of a robot-assisted laparoscopic approach with primary umbilicoplasty. Scand J Urol 2016; 50 (6): 463–7.
11. Gopalan A, Sharp DS, Fine SW et al. Urachal carcinoma: a clinicopathologic analysis of 24 cases with outcome correlation. Am J Surg Pathol 2009; 33: 659–68.
12. Huang C, Luo C, Chao H et al. Urachal anomalies in children: experience at one institution. Chang Gung Med J 2003; 26: 412–6.
13. Joung HJ, Han DY, Kwon WA. Laparoscopic Management of Complicated Urachal Remnants. Chonnam Med J 2013; 49: 43–7.
14. Kim D, Lee J, Park S et al. Initial experience with robotic-assisted laparoscopic partial cystectomy in urachal diseases. Korean J Urol 2010; 51: 318–22.
15. Kumar K, Mehenna D. Injury of urachal diverticulum due to laparoscope port: f case report, literature review and recommendations. J Med Cases 2015; 6 (1): 1–5.
16. Little D, Shah S, St Peter S et al. Urachal anomalies in children: the vanishing relevance of the preoperative voiding cystourethrogram. J Pediatr Surg 2005; 40: 1874–6.
17. Mazzucchelli R, Scarpelli M, Montironi R. Mucinous adenocarcinoma with superficial stromal invasion and villous adenoma of urachal remnants: a case report. J Clin Pathol 2003; 56: 465–7.
18. Moore KL. The developing human: Сlinically oriented embryology. 2nd ed. Philadelfhia: WB Saunders Company, 1977; 307–9.
19. Patrzyk M, Glitsch A, Schreiber A et al. Single-incision laparoscopic surgery as an option for the laparoscopic resection of an urachal fistula: first description of the surgical technique. Surg Endosc 2010; 24: 2339–42.
20. Pedro PJ, Edgar V, Carlos R, Amilcar S. Urachal abscess clinically mimicking a malignancy. Clin Exp Pathol 2012; 4 (1): 154.
21. Rapoport D, Alison R, Goshko V et al. Urachal-Sigmoid Fistula Associated with Diverticular Disease. Canadian Urol Association J 2007; 1: 52–4.
22. Trondsen E, Reiertsen O, Rosseland A. Laparoscopic excision of urachal sinus. Eur J Surg 1993; 159: 127–8.
23. Whitehead A, Arthur LG, Prasad R. Laparoscopic vs Open Excision of Urachal Remnants in Children. J Surgery 2015; 2 (2): 3.
24. Widni EE, Höllwarth ME, Haxhija EQ. The impact of preoperative ultrasound on correct diagnosis of urachal remnants in children. J Pediatr Surg 2010; 45: 1433–7.
25. Yalawar RS, Khanapur R, Patil LS et al. Infected urachal sinus presenting as infraumbilical mass: A Case report and review of literature. IOSR J Dental Med Sci 2014; 13 (8): 12–5.
26. Yiee JH, Garcia N, Baker LA et al. A diagnostic algorithm for urachal anomalies. J Pediatr Urol 2007; 3: 500–4.
27. Koreiba K.A. Oslozhnennoe techenie kisty urahusa. Kazanskij med. zhurn. 2007; 88 (3): 277–8. [in Russian]
28. Kush N.L., Pugachev A.G., Moskalenko V.Z. Hirurgiya porokov pochek i mochevyh putej u detej. Kiev: Zdorov’ya, 1978. [in Russian]
29. Ol'shanetskii A.A., Novoskol'tseva I.G., Levina V.P. i dr. Nagnoenie kisty urakhusa. Khіrurgіia Ukraini. 2014; 2: 121–4. [in Russian]

Авторы

А.А.Гусев*1, С.П.Яцык1,2, И.В.Киргизов1, Е.Ю.Дьяконова1, С.А.Карпачев1, М.В.Рязанов1

1 ФГАУ «Национальный медицинский исследовательский центр здоровья детей» Минздрава России. 119991, Россия, Москва, Ломоносовский пр-т, д. 2, стр. 1;
2 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования»
Минздрава России. 125993, Россия, Москва, ул. Баррикадная, д. 2/1
*drgusev@yandex.ru

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A.A.Gusev*1, S.P.Yacyk1,2, I.V.Kirgizov1, E.Yu.Dyakonova1, S.A.Karpachev1, M.V.Ryazanov1

1 Scientific Center of Children’s Health of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, Lomonosovsky pr-t, d. 2, str. 1;
2 Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation. 125993, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1
*drgusev@yandex.ru

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