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目的 :探讨脐尿管腺癌的临床特点、诊断与治疗。方法 :通过临床表现、体征观察、膀胱镜检活检、经腹壁穿刺活检、B超、CT检查进行确诊 ,手术切除 ,术后随访观察。结果 :7例患者采取上述诊断方法全部于术前确诊为腺癌 ,术后病理细胞学检查发现 7例腺癌全部来源于脐尿管 ,其中低分化腺癌 5例 ,高分化腺癌 2例 ,5例行膀胱部分切除包括覆盖腹膜及脐部腹壁大块切除 ,2例因腹腔内广泛转移 ,仅取活检 ,术后随访 1～ 5年 ,5例肿瘤切除者 2例健在 ,另 3例分别于术后 2年 6个月、3年 2个月肺转移 ,3年 3个月肝转移而死亡 ,2例肿瘤未切除者分别于术后 1年 1个月及 1年 8个月死于肿瘤腹腔转移。结论 :①脐尿管腺癌诊断可根据临床表现、体征、膀胱镜检、活检进行确诊。②B超、CT除协作诊断外 ,能显示肿瘤位置大小、浸润程度及有无转移 ,为制定手术方案提供重要依据。③膀胱前壁或底部肿瘤有钙化灶 ,提示有脐尿管腺癌可能。④治疗以手术完整切除肿瘤及部分膀胱包括覆盖腹膜及脐部腹壁大块组织为佳。⑤脐尿管腺癌以低分化腺癌居多 ,且恶性程度高 ,愈后差
Objective: To investigate the clinical features, diagnosis and treatment of urachal adenocarcinoma. Methods: The clinical manifestations, physical signs, cystoscopy biopsy, transabdominal biopsy, B ultrasound, CT examination were confirmed, surgical resection, postoperative follow-up observation. Results: All the 7 patients were diagnosed as adenocarcinoma preoperatively. Seven cases of adenocarcinoma were all from the urachus after the pathological examination. Among them, 5 cases were poorly differentiated adenocarcinoma and 2 cases were well differentiated adenocarcinoma , 5 cases of partial resection of the bladder, including covering the peritoneum and umbilical abdominal wall resection, 2 cases of extensive metastasis due to intraperitoneal, only biopsy, 1 to 5 years follow-up, 5 cases of tumor resection in 2 cases in the other 3 cases They were respectively lung metastases at 2 years and 6 months, 3 years and 2 months, and liver metastases at 3 years and 3 months respectively. Two cases of tumor resection were dead at 1 year, 1 month and 1 year and 8 months respectively Abdominal cavity metastasis. Conclusion: ① The diagnosis of urachal adenocarcinoma can be diagnosed according to clinical manifestations, signs, cystoscopy and biopsy. ② B ultrasound, CT in addition to collaborative diagnosis, can show the tumor size, invasion and metastasis, to provide an important basis for the development of surgical options. ③ anterior bladder wall or bottom of the tumor calcification, suggesting that there may be urticaria. ④ treatment of complete surgical removal of the tumor and some of the bladder, including the peritoneum and umbilical cord covering the abdominal mass is better. ⑤ urachal adenocarcinoma with poorly differentiated adenocarcinoma majority, and the high degree of malignancy, the worse after