儿科脐部疾病（英文版）课件

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1、PediatricUmbilicalAbnormalitiesScottNguyenMDMountSinaiSchoolofMedicineDeptofSurgeryAbnormalitiesofUmbilicalCordUmbilicalabnormalitiesresultfromfailureofumbilicalringtocloseorpersistenceofumbilicalstructuresUnderstandingembryologyofcordisessentialinunderstandingt

2、hepathophysiologyofumbilicalabnormalitiesEmbryology-3rdweekEmbryologyEmbrologyEmbryology6thwk–midgutloopelongatesandherniatesoutthroughumbilicalcordMidgutrotates270degreesReturnstoabdomenby10thwkAnteriorabdominalwallprogressivelyclosesleavingonlyumbilicalringUmb

3、ilicalAbnormalitiesUrachalAbnormalitiesVitellineDuctAbnormalitiesUmbilicalHerniaOmphalitisDelayedCordSeparationUmbilicalgranulomaUrachalformationBladderformsfromventralportionofcloacaBladderdescendsintopelvisw/urachusconnectingapextoumbilicusUsuallyurachusinvolu

4、testoafibrouscord–medianumbilicalligamentUrachalabnormalitiesfailureofobliterationofurachusresultingcompleteorpartialpatencyofurachus<1/1000livebirthsinflammationordrainagefromumbilicusUS,CT,contraststudies,orinjectionofdyeintotractcanconfirmdiagnosisPatentUrach

5、us(50%)Urachalcyst(30%)Urachalsinus(15%)Vesicourachaldiverticulum(5%)PatentUrachusStudiesCatherizationoftractandinjectionofdyeVoidingcystourethrogramUSUltrasoundCTVCUGTreatmentPatentUrachusPatentUrachusUrachalCystUsuallyassxuntilinfectedRarelybecomeinfectedinnew

6、bornperiod,usumanifestsasyoungadultInfectedUrachalcystFever,voidingsymptoms,midlinehypogastrictenderness,mass,UTIMaydrainintobladderorumbilicusRarelycanruptureintopreperitonealtissuesorperitonealcavityCultures-StaphAureusUSCTInfectedUrachalcyst-treatmentIncision

7、anddrainagePercutaneousdrainageCompletesurgicalexcisionofallurachaltissue30%recurrenceifonlydrainageStagedapproachlimitsamountofbladderresectedUrachalSinusBecomessymptomaticwheninfectedTx–drainageandresectionofurachaltissueSinogramUrachalDiverticulumBlindsacatbl

8、adderapexMostlyassxUrachalDiverticulumVitellineDuctAbnormalitiesVitellineDuctVitellineDuctisconnectionbetweenmidgutandyolksacUsuallyinvolutesin7th–9thweeksVitellinedu