尿膜管疾患14例の臨床的検討

Abstract

尿膜管疾患14例について検討した.その結果, 尿膜管膿瘍は10例で, 臨床症状は下腹部痛/臍部排膿と発熱が多く, 尿細胞診はclass IIが最も多かった.尿膜管癌は4例で, 全例に無症候性肉眼的血尿が見られ, class IIは2例で, 血清腫瘍マーカーの上昇を3例に認めた.尿膜管膿瘍では腹部エコー及びMRIを施行した症例では全例で病巣部を描出することができ, T2強調画像で低信号を呈したが, 尿膜管癌では内部不均一な等～高信号であった.尿膜管膿瘍の8例に尿膜管摘除術を施行し, 尿膜管癌3例には骨盤内リンパ節郭清と尿膜管摘除及び膀胱温存のため膀胱部分切除術を行った.尿膜管癌の2例のみ再発を認め, 両症例共に癌死したが, 尿膜管膿瘍では再発は認めなかった

Diseases associated with persistent urachus are relatively rare. During the past 9-year period, there have been 14 patients with urachal disease consisting of 10 with urachal abscess and 4 with urachal cancer. The 10 patients with urachal abscess consisted of 7 males and 3 females aged 19-77 years (mean, 46 years). The 4 patients with urachal cancer consisted of 2 males and 2 females aged 48-81 years (mean, 57 years). As symptoms, lower abdominal pain was frequently observed in the patients with persistent urachus with abscess and gross hematuria in those with urachal cancer. Echo and magnetic resonance imaging (MRI) were useful for visualizing the lesion. Computed tomogtaphic (CT) scanning could not visualize the lesion in 2 patients. Nine patients underwent MRI, which visualized the lesion in all of them. As urachal abscess, an umbilical fistula was observed in 3 patients, urachal cyst in 4, and urachal diverticulum in 1. The preoperative diagnosis was urachal cancer in 6 patients, and pathological examination showed 4 patients with adenocarcinoma, 1 with inflammatory granuloma, and 1 with pseudosarcoma. Urachal abscess was treated by resection of the abscess in 6 patients, transurethral resection in 1, and resection of the umbilicus and urachus and total cystectomy in the other. Of the patients with urachal cancer, 1 underwent total cystectomy and the other 3 underwent total urachal resection and partial cystectomy. In 2 patients with persistent urachus with abscess, the differentiation between abscess and malignant tumor was difficult.