产科手术相关膀胱损伤的高危因素分析

Analysis of High Risk Factors of Obstetric Operation Related Bladder Injury

目的分析产科手术相关膀胱损伤的高危因素。方法选取2009年1月至2018年12月在首都医科大学附属北京妇产医院产科住院发生膀胱损伤的23例患者为研究对象,统计其病例特点、膀胱损伤发生时机、部位、诊断、并发症治疗及预后等。结果在136969例分娩产妇中,56776例为剖宫产术,其中膀胱损伤23例,在总分娩中的发生率为0.016%,在总剖宫产手术中的发生率为0.04%;其中18例(78.0%)患者术前有盆腔手术史,10例(43.5%)为急诊手术,9例(39.1%)合并胎盘植入或前置胎盘,6例(26.1%)行子宫切除术。所有病例均在术中发现并及时缝合膀胱,预后均良好,无再次手术及术后尿瘘发生。结论产科手术膀胱损伤的高危因素包括合并前壁胎盘植入侵及膀胱,盆腔局部粘连及手术者技巧。术中靠肉眼即可诊断膀胱损伤,发现后及时行膀胱修补术多预后良好。

Objective To investigate the risk factors of bladder injury related to obstetric surgery.Methods From Jan.2009 to Dec.2018,23 patients with bladder injury in the Department of Obstetrics in Beijing Gynecology and Obstetrics Hospital,Capital Medical were included,and the characteristics of the cases,the timing,location,diagnosis,treatment of complications and prognosis of the bladder injury were analyzed,and the results were statistically analyzed.Results Among 136969 parturients,567776 cases underwent cesarean section,of which 23 cases had bladder injury,the incidence of total delivery was 0.016%,of total cesarean section was 0.04%.18 cases(78.0%)of them had a history of pelvic surgery,10 cases(43.5%)underwent emergency surgery,9 cases(39.1%)had placenta accreta or placenta previa,6 cases(26.1%)had hysterectomy after cesarean section.All cases were diagnosed and repaired in time during the operation,and the prognosis was good,with no urinary fistula nor secondary repair.Conclusion The risk factors of bladder injury in obstetric surgery include:placenta accrete/previa invading bladder;pelvic local adhesion and surgical skills.During the operation,the bladder injury can be diagnosed directly by the naked eye,and the prognosis is mostly good with timely repair.