骨盆骨折合并尿道断裂及膀胱破裂的急诊处理

目的探讨骨盆骨折并发后尿道断裂及膀胱破裂的急诊诊断与治疗,提高骨盆骨折的抢救成功率。方法回顾性分析我院急诊及泌尿外科2000—2010年收治的骨盆骨折合并尿道断裂及膀胱破裂52例患者的临床资料。结果52例中合并后尿道断裂41例,合并膀胱破裂15例,4例同时有后尿道断裂和膀胱破裂二种合并伤。41例合并后尿道断裂中6例病情较重,只行膀胱穿刺造瘘,29例行尿道会师术加牵引,6例未能手术;15例合并膀胱破裂的患者中2例行尿道会师术和膀胱修补术,另外11例膀胱破裂者行膀胱修补术,2例未能手术。本组患者死亡8例,病死率15．4％（8／52）,6例未能行急诊手术者死于不可控制的出血,2例死于术后多器官功能衰竭。结论骨盆骨折并发症多,应尽早明确诊断;对常规抗休克无效者可在急诊行骨盆外固定术及急诊介入栓塞术止血,待病情稳定后进行相关处理。     

Bedside ultrasound diagnosis of a traumatic bladder rupture

Background

Urinary bladder rupture is a complication of both blunt and penetrating trauma. Significant morbidity and mortality can result from a missed rupture and its ensuing complications. Patients who are at risk for traumatic bladder rupture should undergo appropriate testing to expedite the diagnosis. Current diagnostic modalities include computed tomography (CT) cystography, and retrograde cystography. Although these modalities carry a sensitivity and specificity of 95-99% and 95-100%, their utility is limited by the resources and staff available. Furthermore, both techniques require that a potentially hemodynamically unstable trauma patient be transported out of the Emergency Department for the entire duration of the procedure.

Objective

The following case report reviews the incidence and management of traumatic bladder rupture and describes how emergency physicians (EP) can use ultrasound to make this diagnosis quickly and safely at the bedside.

Case Report

The case report describes a patient involved in a motor vehicle collision with a history concerning for urinary bladder injury. A bedside ultrasound study performed by the EP was used to establish the diagnosis of urinary bladder rupture. The ultrasound demonstrated a small contracted urinary bladder with copious free fluid anterior to the bladder wall. The diagnosis was confirmed by CT and the patient was taken expeditiously to the operating room.

Conclusion

This case provides an example of how bedside ultrasound can be used to make an accurate and timely diagnosis of urinary bladder rupture and help expedite patient care.     

Preterm premature rupture of membranes: diagnosis and management

Preterm premature rupture of membranes is the rupture of membranes during pregnancy before 37 weeks' gestation. It occurs in 3 percent of pregnancies and is the cause of approximately one third of preterm deliveries. It can lead to significant perinatal morbidity, including respiratory distress syndrome, neonatal sepsis, umbilical cord prolapse, placental abruption, and fetal death. Appropriate evaluation and management are important for improving neonatal outcomes. Speculum examination to determine cervical dilation is preferred because digital examination is associated with a decreased latent period and with the potential for adverse sequelae. Treatment varies depending on gestational age and includes consideration of delivery when rupture of membranes occurs at or after 34 weeks' gestation. Corticosteroids can reduce many neonatal complications, particularly intraventricular hemorrhage and respiratory distress syndrome, and antibiotics are effective for increasing the latency period.     

超声诊断完全性重复膀胱伴不完全性重复尿道1例

<正>患者女,27岁,偶发尿频、尿不尽6年余,曾于外院诊断输卵管积液;无其他特殊病史。查体及实验室检查均未见明显异常。经腹联合经阴道超声：于膀胱左后上方探及122 mm×40mm囊性占位,形态尚规则,张力较高,囊壁呈强、弱及强三层结构回声,2个尿道内口呈前后位,分别与膀胱及左侧囊性占位相连,于尿道下段融合成一个尿道外口（图1A）;右侧输尿管开口于膀胱,左侧输尿管向下走行,     

经尿道膀胱肿瘤电切术治疗浅表性膀胱肿瘤临床分析

目的探讨经尿道膀胱肿瘤电切术(TURBT)治疗浅表型膀胱肿瘤的疗效。方法对我院收治的56例浅表性膀胱肿瘤患者施行TURBT,术后辅以丝裂霉素膀胱灌注治疗。结果所有患者均一次性成功,未出现膀胱穿孔、电切综合征及术后大出血。术后随访3~36个月,8例出现复发,复发率14.27%,复发患者再行TURBT,术后再随访,无复发患者。结论 TURBT治疗浅表性膀胱肿瘤,具有创伤小、手术时间短、术后恢复快、可多次重复等优点,避免了患者多次进行开放性手术所带来的创伤,同时可保留膀胱功能,极大地减少了膀胱肿瘤患者的痛苦,值得推广。     

原发性输尿管肿瘤的影像诊断

目的评价X线检查及CT扫描对原发性输尿管肿瘤的诊断价值及限度。方法对患者行静脉肾盂造影及逆行尿路造影和CT扫描。结果可清晰显示病变部位、病灶的形态、浸润的深度、管腔的狭窄程度、输尿管周围状况以及有无远处转移。结论X线检查及CT扫描对原发性输尿管肿瘤的明确诊断有重要价值。