先天性耻骨前窦道与耻骨上窦道

Congenital Prepubic Sinus versus Suprapubic Sinus

摘要: 目的：总结4例儿童先天性耻骨前窦道病例的诊疗经验，探讨与耻骨上窦道的区别。方法：回顾性分析2017年7月至2021年4月，我院收治的4例先天性耻骨前窦道患儿的临床表现、手术方法及疗效。同时结合文献分析与耻骨上窦道的区别。结果：4例患儿均表现为下腹部中线上脐与尿道或阴蒂根部之间异常窦道。术前超声诊断为皮下窦道，术中经窦道外口注入美兰证实窦道未与膀胱或脐尿管残迹相连，均完整切除窦道并证实窦道为盲端，最终诊断为先天性耻骨前窦道。耻骨上窦道来源于脐尿管残迹，远端同样可异常开口于下腹部中线上脐至耻骨联合之间，但窦道近端与脐尿管相通。手术需切除窦道并同时切除脐尿管以防癌变、复发或继发感染。结论：先天性耻骨前窦道和耻骨上窦道均为小儿下腹壁中线处罕见畸形，但二者发病机制不同，虽临床表现相似且均需手术切除，但手术方式存在差别。

Abstract: Objective: To review the experience of diagnosing and treating congenital prepubic sinus in children. To investigate the difference between congenital prepubic versus suprapubic sinus. Methods From March 2017 to April 2021, 4 infants congenital prepubic sinus patients were admitted to our institute. Preoperative ultrasound about the sinus was performed. Methylene blue was injected into sinus as a guide during operation. Results: All the four congenital prepubic sinus were located between the root of the penis and the umbilicus diagnosed as dermal sinus by US, and were completely resected. These tracts were not in any relationship to bladder or urachus with the blind ending. While suprapubic sinus is related to the urachus and terminates at bladder or median umbilical ligament. During the resection, both sinus and urachus needed to be respected for preventing carcinogenesis, recurrence or infection. Conclusion: Suprapubic sinus and congenital prepubic sinus are two different rare pathologies in children with sinus opening in the lower abdomen, with quite similar presentation but need different operation methods.