Cottam D, Gorecki P J, Curvelo M, Shaftan G W
Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554, USA.
Surg Endosc. 2001 Dec;15(12):1488-9. doi: 10.1007/s00464-001-4116-y.
Laparoscopy as a diagnostic modality in trauma has been reported. However, therapeutic laparoscopy for trauma remains a controversial subject. We present a case of laparoscopic repair of a traumatic bladder rupture. A 25-year-old man was brought to the emergency room after a head-on collision. Physical examination was unremarkable with the exception of gross hematuria upon insertion of a urinary catheter. Computed tomography scan of the abdomen demonstrated a small amount of free intraperitoneal fluid. An anteroposterior cystogram was obtained which showed no intraperitoneal or extraperitoneal leak. Repeat examinations of the abdomen revealed a mild tenderness in the lower abdomen. Because of the presence of unexplained free intraperitoneal fluid and equivocal signs of peritoneal irritation, exploratory laparoscopy was performed. Three 5-mm ports and a 5-mm laparoscope were used. Laparoscopic examination of the abdomen revealed a 4-cm rupture at the dome of the bladder. The laceration was sutured in two layers using an intracorporeal technique. The patient was discharged on the second postoperative day with indwelling urinary catheter. Eight days after the operation, a repeated cystogram revealed no evidence of leak. We believe that laparoscopic exploration for trauma in hemodynamically stable patients is feasible. The repair of simple intraabdominal injuries such as bladder rupture can be safely performed.
腹腔镜检查作为创伤的一种诊断方式已有报道。然而，创伤性腹腔镜治疗仍是一个有争议的话题。我们报告一例腹腔镜修复创伤性膀胱破裂的病例。一名25岁男性在正面碰撞后被送往急诊室。体格检查无异常，插入导尿管时除外肉眼血尿。腹部计算机断层扫描显示腹腔内有少量游离液体。获得了一张前后位膀胱造影照片，显示无腹腔内或腹膜外渗漏。对腹部的重复检查显示下腹部有轻度压痛。由于存在无法解释的腹腔内游离液体和腹膜刺激的可疑体征，进行了探索性腹腔镜检查。使用了三个5毫米的端口和一个5毫米的腹腔镜。腹腔镜检查发现膀胱顶部有一个4厘米的破裂口。使用体内技术将撕裂伤分两层缝合。患者术后第二天留置导尿管出院。术后八天，重复膀胱造影显示无渗漏迹象。我们认为，对于血流动力学稳定的患者，腹腔镜探查创伤是可行的。简单的腹腔内损伤如膀胱破裂的修复可以安全地进行。
