老年人自发性膀胱破裂28例报告

目的　总结老年人自发性膀胱破裂的临床特征、诊断和治疗方法。方法　对 2 8例老年人自发性膀胱破裂患者的临床资料进行回顾性分析。结果　行膀胱修补术者 2 3例 ,其中腹膜内型膀胱破裂者 19例 ,腹膜外型膀胱破裂者 4例。未手术者 5例 ,其中 3例保守治疗痊愈。死亡 4例 ,死亡率为 15 %。引起自发性膀胱破裂的病因以下尿路梗阻和肿瘤居多。尿液性腹水和氮质血症是腹膜内型自发性膀胱破裂的特征性表现。结论　B超为首选的检查手段 ;膀胱造影是最敏感的检查手段 ,对腹膜内型膀胱破裂的诊断意义较大 ;增强CT对腹膜外型膀胱破裂的诊断有价值。早期诊断、及时治疗是治愈的关键。

Spontaneous bladder rupture in the elderly (A report of 28 cases)

Objective To study clinical features, diagnosis and treatment of spontaneous bladder rupture in the elderly.Method Diagnosis and therapeutic outcomes of spontaneous bladder rupture in 28 senile cases were reviewed.Results Surgical repair were performed in 23 of the 28 cases with spontaneous bladder repture, including 19 cases with intraperitoneal bladder rupture, and 4 cases with extraperitoneal bladder rupture. Surgical operation was not performed in 5 cases and 3 of them were healed with conservative treatment. There were 4 deaths with case-fatality ratio of 15% (4/28). Etiology of spontaneous bladder rupture in the elderly mianly included bladder outflow obstruction and bladder neoplasma. Urinary ascites and azotemia were characterisitic manifestations of spontaneous bladder rupture in the elderly. Conclusions Type B ultrasonography was screening test of choice for all suspected cases of spontaneous bladder rupture. Cystography was the most sensitive technique in diagnosis for intraperitoneal disorders and enhanced CT had diagnotic value for extraperitoneal ones. Early diagnosis and timely treatment were key to cure of it.