腹腔镜下修补腹膜内型膀胱破裂的可行性与安全性分析

Analysis of the feasibility and safety of laparoscopic repair of intraperitoneal bladder rupture

目的:探讨腹腔镜下修补腹膜内型膀胱破裂的可行性与安全性。方法:回顾分析2008年8月至2014年11月为16例腹膜内型膀胱破裂患者行腹腔镜诊治的临床资料。腹腔镜下观察膀胱破裂位置、大小、破裂口与输尿管开口的位置关系,探查有无合并腹腔其他脏器损伤。2-0可吸收线连续全层缝合膀胱破裂口,膀胱灌注含有亚甲蓝的生理盐水200 ml检查有无渗漏,必要时再次加固缝合。盆腔内留置引流管一根。结果:16例均证实为腹膜内型膀胱破裂,均于腹腔镜下用2-0可吸收线连续全层缝合膀胱破裂口,手术时间平均(58±8)min,术中失血量平均(45.0±5.5)ml。术后患者均恢复良好,术后平均住院(9.0±0.7)d,无切口感染、尿瘘、发热、肠梗阻等并发症发生。结论:腹腔镜下修补腹膜内型膀胱破裂可行、安全,并具有创伤小、痛苦小、康复快、并发症少、美容效果好等优点。

Objective：To investigate the feasibility and safety of laparoscopic repair of intraperitoneal bladder rupture. Meth- ods： Retrospective analysis was made on the clinical data of 16 patients who suffered from intraperitoneal bladder rupture and underwent laparoscopic diagnosis and treatment from Aug. 2008 to Nov. 2014. The location and size of the bladder rupture and the positional rela- tionship between the rupture and ureteral opening were observed, whether other abdominal organ injuries existed were probed. Full- thickness continuous suture was performed for the rupture with 2-0 absorbable thread, then 200 ml of saline containing methylene blue was put into bladder to check for leaks, reinforced stitching was performed again if necessary, indwelling drainage tube was placed in the pelvic cavity. Results：Sixteen patients were confirmed as intraperitoneal bladder rupture, the rupture was full-thickness continuous sutured with 2-0 absorbable thread in laparoscopy. The mean operative time was （58± 8 ） min ,the mean operative blood loss was （45.0 ±5.5 ） ml, the average postoperative hospital stay was （9.0±0. 7 ） d, patients uneventfully recovered without incision infection, urinary fistula, fever, intestinal obstruction or other complications. Conclasions：Laparoscopic repair of intraperitoneal bladder rupture is feasible and safe with less trauma, less pain, faster recovery, fewer complications, better cosmetic results and so on.