钝性膀胱损伤16例诊疗及文献复习

Diagnosis and treatment of 16 cases of blunt bladder injury and review of the literature

目的探讨钝性膀胱损伤的诊疗方法。方法回顾性分析2021年9月—2023年1月河北医科大学第三医院救治的钝性膀胱损伤患者16例,男性12例,女性4例;年龄28~75岁,平均42.9岁;道路交通伤10例,重物砸伤3例,高处坠落伤3例。腹膜外型膀胱破裂10例,腹膜内型膀胱破裂4例,均行膀胱破裂修补术;膀胱挫伤2例,均为非手术治疗。结果本组16例患者中并发膀胱填塞2例,下肢深静脉血栓5例,最终均恢复良好。14例膀胱破裂患者一期手术成功率为100%,住院时间7~39 d,平均20.6 d;手术时长81~170 min,平均129.6 min;最终伤口均愈合良好。2例膀胱挫伤患者经非手术治疗后顺利出院。随访1~6个月,治疗效果满意。结论多方法联合评估是提高钝性膀胱损伤诊断效率的关键。对于膀胱挫伤患者,非手术治疗效果良好;对于复杂性膀胱破裂或膀胱破裂并发膀胱填塞患者,及早行膀胱破裂修补术,能够提高患者治愈率,但术后应注意预防下肢深静脉血栓形成。

Objective To explore the diagnosis and treatment of blunt bladder injuries.Methods A retrospective analysis was conducted on 16 patients with blunt bladder injuries treated in the Hebei Medical University Third Hospital from Sep.2021 to Jan.2023,including 12 males and 4 females aged 28-75 years,mean 42.9 years.There were 10 cases of road traffic injuries,3 crash injuries by heavy objects,and 3 falls from height.Among them,there were 10 cases of extraperitoneal bladder rupture and 4 intraperitoneal bladder rupture,all of which underwent bladder rupture repair;the other 2 cases were bladder contusion and treated non-surgically.Results Of the 16 patients in this series,2 complicated bladder tamponade and 5 had lower extremity deep vein thrombosis,all of which eventually recovered well.As for the 14 patients with bladder rupture,the one-stage surgery showed a 100%success rate,with a hospitalization time of 7-39(mean 20.6)d,operation time of 81-170(mean 129.6)min,and wellhealed wounds at final follow-up.For the 2 patients with bladder contusion,they were discharged successfully after conservative treatment,followed up of 1-6 months,all patients attained satisfactory treatment effects.Conclusion Multi-method evaluation is the key to improving the diagnostic efficiency of blunt bladder injuries.For patients with bladder contusion,non-surgical treatment is effective with good outcomes;for patients with complex bladder rupture or bladder rupture complicated with bladder tamponade,early bladder rupture repair can improve the cure rate of patients,but attention should be paid to prevent lower extremity deep vein thrombosis.