膀胱破裂21例诊治分析

目的提高对膀胱破裂的认识。方法回顾性分析21例膀胱破裂患者的临床资料。结果20例行膀胱破裂修补术,1例留置大口径尿管保守治疗,均治愈出院。结论膀胱造影及B超检查是诊断膀胱破裂的主要方法,手术是治疗膀胱破裂的主要手段。     

外伤性膀胱破裂的诊断与治疗体会(附40例报告)

目的 总结外伤性膀胱破裂的诊断与治疗经验。方法 对40例膀胱破裂患者的诊断与治疗进行回顾性分析。方法对40例膀胱破裂患者的诊断与治疗进行回顾性分析。结果本组手术治疗37例，非手术治疗3例，均临床治愈。术后并发症均经相应治疗而痊愈。术后并发症均经相应治疗而痊愈。结论 CT检查是诊断膀胱破裂的最佳方法，特别是对膀胱裂口小或小裂口被阻塞时的诊断优于膀胱逆行造影，可作为首选检查项目。治疗应视情况而定，我们倾向于早期手术治疗，既可及时修补膀胱，充分引流尿外渗，又能探查及时处理合并伤。     

外伤性膀胱破裂诊治的临床分析

目的探讨外伤性膀胱破裂的诊断及治疗方法,提高外伤性膀胱破裂的临床诊治水平。方法对23例外伤性膀胱破裂患者的病因、类型、临床表现、诊断方法、治疗方法及效果进行回顾性总结和分析。结果 23例中腹膜外型膀胱破裂15例,腹膜内型膀胱破裂8例。非手术治疗5例,均为腹膜外型膀胱破裂。手术治疗18例,其中腹膜外型膀胱破裂10例,腹膜内型膀胱破裂8例。23例患者均均治愈出院,未发生盆(腹)腔脓肿等严重并发症及死亡病例。结论膀胱造影应作为诊断外伤性膀胱破裂的首选方法。腹膜内型膀胱破裂应尽早手术治疗,无严重合并伤的腹膜外型膀胱破裂可考虑行非手术治疗。早期诊断,积极、合理、正确治疗,对降低外伤性膀胱破裂患者并发症发生率和病死率至关重要。     

9例肾移植术后尿瘘的治疗

目的探讨肾移植术后尿瘘并发症的合理治疗方法。方法共治疗9例尿瘘患者,3例单纯经尿道留置Foley导尿管治愈,2例原引创口流口管置入普通导尿管 留置膀胱Foley导尿管双向引流,1例经膀胱镜逆行置入输尿管支架 留置膀胱Foley导尿管、1例行尿性囊肿切排术加留置膀胱Foley导尿等方法治愈,1例进行了开放手术输尿管膀胱重新吻合术 置入输尿管支架,1例行输尿管膀胱肌瓣吻合术无效后,行自体输尿管与移植肾输尿管吻合术。结果所有病例尿瘘治愈,随访1个月～3年,无一例发生输尿管并发症。结论对于肾移植术后尿瘘治疗,可以先采用无创或微创治疗手段,在无创或微创的治疗手段无效后及时采取手术干预。     

15例外伤性膀胱破裂病人的临床诊治体会

目的：探讨外伤性膀胱破裂的临床治疗方法及效果。方法回顾性分析2012年6月至2014年4月来本院就诊的15例外伤性膀胱破裂病人的临床资料。结果其中2例膀胱裂口小患者采用非手术方法,尿管引流联合抗感染治疗,2周后拔管并获得治愈;剩余13例手术膀胱修补者均Ⅰ期愈合,术后1～2周根据病情拔除导尿管,均可恢复正常排尿;5例病人住院期间输血,2例后尿道断裂患者拔管后行尿道扩张术恢复;平均住院时间9.5天,无继发性出血、尿路感染、膀胱漏等并发症,切口甲级愈合且预后良好。结论导尿及膀胱注水试验为膀胱破裂最简单的诊断方法,而膀胱逆行造影检查可确诊膀胱破裂;非手术治疗适用于裂口小的外伤性膀胱破裂,手术治疗仍是膀胱破裂的主要治疗手段。     

肾移植术后尿瘘的治疗策略研究(附72例报告)

目的探讨肾移植术后尿瘘并发症的治疗策略。方法回顾性分析2008年6月至2012年12月在解放军第309医院全军器官移植研究所接受同种异体肾移植术的1 228例患者中,术后发生尿瘘的72例患者的临床资料。结果本组尿瘘发生率为5.86%。患者确诊后,首先保持输尿管支架管留置状态,并采取留置Foley导尿管的方法,在确认无效后在原创口或引流口置入普通导尿管或乳胶管引流,最后采取手术治疗,均采用无张力吻合。72例尿瘘患者中,46例经保守治疗后治愈,26例保守治疗无效后采用手术治疗,其中12例行瘘口修补术+留置膀胱Foley导尿管、10例行输尿管-膀胱重新吻合术+置入输尿管支架治愈,4例行输尿管-膀胱肌瓣吻合术无效后,行自体输尿管-移植肾输尿管吻合术后治愈。2例出现局部伤口感染,经加强引流及抗感染治疗后治愈。结论肾移植术后尿瘘预防胜于治疗,早期诊断、正确选择治疗措施是成功救治的关键。患者确诊后,首先采用保守治疗,确认无效后采取手术治疗,遵循无张力吻合原则。     

Foley尿管气囊压迫治疗骶前静脉丛大出血的评价(附6例报告)

目的:评价直肠癌根治术中用Foley尿管气囊压迫治疗骶前静脉丛大出血(MPVP)的临床价值。方法:分析1995~2005年用Foley尿管气囊压迫治疗骶前静脉丛大出血6例的临床资料。结果:6例骶前大出血中全部用Foley尿管气囊压迫控制出血,术中出血量为800~1700mL,Foley尿管于术后4d拔除3例,5d1例,6d2例,均无再出血,会阴切口均一期愈合。结论:Foley尿管气囊压迫治疗骶前静脉丛大出血是一种简单安全有效的治疗方法。     

混合型膀胱破裂的非手术治疗(附1例报告)

目的:探讨混合型膀胱破裂的非手术治疗方法。方法:回顾性分析1例混合型膀胱破裂患者的临床资料:在心电监护下,观察生命体征,给于右侧胸腔闭式引流,膀胱置F22三腔尿管引流,观察引流液量及颜色,并抗感染、抗休克、营养支持治疗。结果:治疗1个月复查CT膀胱逆行造影,膀胱结构完整,膀胱壁光整,膀胱周围未见造影剂渗出。行膀胱功能锻炼2周后拔出尿管,排尿通畅。结论:采用非手术方法治疗膀胱破裂要综合评估患者病情,慎重选择,同时要严密观察病情变化,若病情恶化应及时改行开放手术修补。     

Foley尿管在肾癌合并下腔静脉癌栓中的应用

目的探讨应用Foley尿管在肾癌合并下腔静脉癌栓肾癌根治术时取出癌栓的效果。方法2001年10月~2008年6月收治肾癌合并腔静脉癌栓患者15例,肾癌根治术术中应用Foley尿管取出癌栓11例,其中Ⅲ型癌栓5例,Ⅳ型癌栓6例。术中先游离肾脏及肾动、静脉,结扎肾动脉,游离出对侧肾静脉及癌栓上下的腔静脉并阻断,在患肾对侧的腔静脉壁纵行剪开3~4 cm,插入Foley尿管,气囊内注入20 mL生理盐水,用Foley尿管将癌栓牵出腔静脉外,取下患肾和癌栓,阻断腔静脉进行缝合。结果11例手术顺利,全部将癌栓完整取出,手术时间3~5 h,出血量200~1 000 mL。结论肾癌合并腔静脉癌栓在肾癌根治术中用Foley尿管取出癌栓可避免开胸或体外循环,减少手术损伤,疗效良好。     

56例膀胱破裂的诊断与治疗体会

目的:探讨膀胱破裂的诊断与治疗方法。方法:回顾性分析56例膀胱破裂的诊断与治疗资料。结果:56例中,腹膜内膀胱破裂54例,行膀胱修补术;腹膜外膀胱破裂2例,保守治疗。结论:导尿注水试验和膀胱造影是诊断膀胱破裂最可靠的方法;个别症状不典型的患者可行膀胱镜检。对绝大部分膀胱破裂需行膀胱修补术,对病情较轻的腹膜外膀胱破裂可留置三腔气囊尿管,保守治疗。     

Recurrent spontaneous bladder rupture. A case report

Spontaneous (non-traumatic) intraperitoneal rupture of the bladder in a 37-year-old pregnant woman was repaired at laparotomy. Nine months later she again presented with an intraperitoneal bladder rupture during pregnancy and fatal sepsis. Histological examination of the resected bladder wall showed acute ulcerative and necrotising cystitis. All patients with apparently spontaneous bladder rupture should undergo full urological evaluation to identify possible disease which might lead to recurrent rupture.     

外伤性膀胱破裂7例报告

目的：探讨外伤性膀胱破裂的诊治方法。方法：分析外伤性膀胱破裂７例，６例行膀胱灌注试验确诊，１例因尿道断裂行尿道会师术时发现。７例均行膀胱修补术，其中５例行膀胱造瘘术，２例留置导尿管引流。结果：７例均痊愈，术后排尿正常。结论：膀胱灌注试验结合腹腔穿刺检查是膀胱破裂简单而可靠的诊断方法。     

Bladder rupture associated with pelvic fracture due to blunt trauma

A total of 103 patients with pelvic fracture due to blunt trauma were evaluated by cystography and 10 cases of bladder rupture were identified. Risk factors associated with the likelihood of bladder rupture included gross hematuria, the number of fractured pubic rami, tachycardia, hypotension, and declining hematocrit. We conclude that since 90 percent of the patients do not have bladder rupture when a pelvic fracture is encountered, cystography may be safely reserved for those patients with pelvic fracture who are considered to be at high risk for such an injury.     

Nonoperative treatment of isolated posttraumatic intraperitoneal bladder rupture in children-is it justified?

PURPOSE: Open surgical repair has been the standard treatment for intraperitoneal bladder rupture. We sought to explore the possibility of nonoperative treatment of isolated intraperitoneal bladder rupture in children. MATERIALS AND METHODS: Eight children (4 girls and 4 boys) with a mean age of 6.3 +/- 4.6 years (range 1 to 13) presented with isolated posttraumatic intraperitoneal bladder rupture between 1993 and 2003. Retrograde cystogram was performed in all cases. Diagnosis was confirmed by aspiration and chemical analysis of the free intraperitoneal fluid in patients with an equivocal cystogram. Four patients who presented early in the series (group 1) were treated with the classic open repair, whereas the last 4 patients (group 2) were treated nonoperatively with adequate bladder drainage and percutaneous intraperitoneal tube drain. The mechanisms of injury, clinical presentation, management, complication, hospital stay and duration of catheterization were reviewed in both groups. RESULTS: Six patients had a history of a direct blow to the full bladder, while 2 presented following a motor vehicle accident. All patients presented with vomiting and abdominal distention, and 5 had mild gross hematuria without associated clots or hemodynamic instability. One patient in group 1 had early urinary leakage and wound sepsis, and was treated conservatively. All patients in group 2 demonstrated significant improvement in general condition within a few hours of the bladder and peritoneal drainage. Intraperitoneal tube drains were removed at 1 to 4 days. There were no post-intervention complications in group 2 and surgical treatment was never required. Mean indwelling catheter duration was 9.3 +/- 7.9 and 11.8 +/- 2.6 days (p = 0.24), and mean hospital stay was 10.5 +/- 8.4 and 7.3 +/- 3.9 days (p = 0.56) in groups 1 and 2, respectively. CONCLUSIONS: Nonoperative treatment is a justified initial approach for isolated intraperitoneal bladder rupture in children. Indications for surgical intervention include improper bladder drainage, unduly prolonged urinary drainage through the peritoneal drain and/or lack of clinical improvement.     

Current Experience with Computed Tomographic Cystography and Blunt Trauma

We present our experience with computed tomographic (CT) cystography for the diagnosis of bladder rupture in patients with blunt abdominal and pelvic trauma and compare the results of CT cystography to operative exploration. We identified all blunt trauma patients diagnosed with bladder rupture from January 1992 to September 1998. We also reviewed the radiology computerized information system (RIS) for all CT cystograms performed for the evaluation of blunt trauma during the same time period. The medical records and pertinent radiographs of the patients with bladder rupture who underwent CT cystography as part of their admission evaluation were reviewed. Operative findings were compared to radiographic findings. Altogether, 316 patients had CT cystograms as part of an initial evaluation for blunt trauma. Of these patients, 44 had an ultimate diagnosis of bladder rupture; 42 patients had CT cystograms indicating bladder rupture. A total of 28 patients underwent formal bladder exploration; 23 (82%) had operative findings that exactly (i.e., presence and type of rupture) matched the CT cystogram interpretation. The overall sensitivity and specificity of CT cystography for detection of bladder rupture were 95% and 100%, respectively. For intraperitoneal rupture, the sensitivity and specificity were 78% and 99%, respectively. CT cystography provides an expedient evaluation for bladder rupture caused by blunt trauma and has an accuracy comparable to that reported for plain film cystography. We recommend CT cystography over plain film cystography for patients undergoing CT evaluation for other blunt trauma-related injuries.     

Ischemic necrosis: a hypothesis to explain the pathogenesis of spontaneously ruptured enterocystoplasty

Spontaneous enterocystoplasty rupture represents a devastating and potentially fatal late complication. Previously proposed mechanisms of rupture include catheter trauma, chronic infection, avulsion of adhesions between the bowel patch and peritoneum, and chronic overdistension with elevated intravesical pressures. We have witnessed this complication 4 times in 3 patients 5 weeks to 46 months postoperatively. Tissue specimens from 3 episodes in 2 patients with detubularized sigmoid enterocystoplasties were available for histological examination. All patients had a neurogenic bladder from myelomeningocele, all had an AMS800 artificial urinary sphincter and all had a documented history of chronic distension from inadequate emptying of the augmented bladder. At exploration, all of the ruptures were found within the bowel segment near the bladder apex in an area remote from the anastomotic line. In each case tissue specimens from the rupture site showed marked vascular congestion, intramural hemorrhage, abundant hemosiderin laden macrophages, myofiber atrophy and intravascular thrombi. These features are interpreted to reflect the sequelae of vascular compromise and ischemia. We propose that enterocystoplasty rupture results from ischemia, possibly due to chronic overdistension and subsequent vascular compromise. This mechanism may account for many of the previously reported cases of enterocystoplasty rupture.     

腹腔镜与开放手术治疗腹膜内型膀胱破裂的疗效比较

目的：比较腹腔镜与开放手术治疗腹膜内型膀胱破裂的疗效。方法50例腹膜内型膀胱破裂患者,26例行腹腔镜膀胱破裂修补术,24例行开放膀胱破裂修补术。比较两组手术时间、术中出血量、肠道恢复时间、住院时间、止痛药的使用率及并发症的发生率。结果两组手术均顺利完成,腹腔镜组与开放组手术时间分别为（55．12±8．53）min 和（64．48±13．21）min,差异有统计学意义（P ＞0．05）;术中出血量分别为（54．24±5．38）ml 和（89．35±12．17）ml,P ＜0．05;肠道功能恢复时间分别为（23．24±2．39）h 和（38．42±6．98）h,差异有统计学意义（P ＜0．05）;住院时间分别为（4．64±1．42）d 和（7．04±1．29）d,差异有统计学意义（P ＜0．05）;止痛药的使用率分别为38．46％（10／26）和75．00％（18／24）,差异有统计学意义（P ＜0．05）;术后并发症发生率分别为7．69％（2／26）和8．33％（2／24）,差异无统计学意义（P ＞0．05）。结论与开放术式比较,腹腔镜治疗腹膜内型膀胱破裂具有创伤小、恢复快等优点。     

Computerized tomography cystography for the diagnosis of traumatic bladder rupture

PURPOSE: We present our experience with computerized tomography (CT) cystography for diagnosing bladder rupture in patients with blunt abdominal and pelvic trauma, and compare the results of CT cystography with those of surgical exploration. MATERIALS AND METHODS: We identified all patients with blunt trauma diagnosed with bladder rupture from 1992 to September 1998. We reviewed the radiology computerized information system for all CT cystography performed to evaluate blunt trauma during the same period. We also reviewed the medical records and pertinent radiographic studies of patients with bladder rupture who underwent CT cystography as part of the hospital admission evaluation. Operative and radiographic findings were compared. RESULTS: CT cystography was performed in 316 patients as part of the initial evaluation of blunt trauma. Of the 44 patients with the ultimate diagnosis of bladder rupture CT cystography revealed bladder rupture in 42, while 23 of the 28 (82%) who underwent formal bladder exploration had operative findings that exactly matched the CT cystography interpretation in terms of the presence and type of rupture. In the 316 patients CT cystography detected bladder rupture with an overall sensitivity and specificity of 95% and 100%, respectively. For intraperitoneal rupture sensitivity was 78% and specificity was 99%. CONCLUSIONS: CT cystography provides expedient evaluation of bladder rupture due to blunt trauma and has accuracy comparable to that reported for plain film cystography. We recommend CT cystography over plain film cystography in patients undergoing CT for other injuries associated with blunt trauma.     

Laparoscopic repair of bladder rupture in a neonate

Bladder rupture in a fetus is a rare occurrence. We report the first neonatal case of laparoscopic repair for prenatally diagnosed bladder rupture. A male neonate, who had presented with megacystis, bilateral hydronephrosis and hydroureters since 27 weeks‐of‐gestation, was delivered by emergency cesarean section because of sudden collapse of the bladder with massive ascites at 37 weeks‐of‐gestation. The diagnosis of bladder rupture was made by retrograde urethrocystography. Laparoscopic repair was carried out subsequent to urethral catheterization. Intraoperatively, laceration from the left side of the bladder dome to the posterior wall was observed. This tear was successfully repaired using a two‐layer interrupted suture without any postoperative complications. Laparoscopic repair could be the treatment of choice for bladder rupture, because it has the advantage of closure of the perforated site more certainly than bladder decompression alone, and with better cosmesis than open repair.     

Management of the ruptured bladder: seven years of experience with 111 cases

During a 7 year period, we have seen 111 patients with bladder rupture, 95 from blunt trauma and 16 due to penetrating injuries. All 16 patients with penetrating injuries, as well as an additional 34 patients with intraperitoneal injuries, nine patients with extraperitoneal injuries, and five with both intra- and extraperitoneal injuries from blunt trauma, had formal closure of the wound and urethral or suprapubic catheter drainage. All did well. A total of 39 patients with extraperitoneal bladder injuries were treated with only catheter drainage and all did well. Eight patients died before institution of therapy.