Osman Yasser, El-Tabey Nasr, Mohsen Tarek, El-Sherbiny Mohamed
Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
J Urol. 2005 Mar;173(3):955-7. doi: 10.1097/01.ju.0000152220.31603.dc.
Open surgical repair has been the standard treatment for intraperitoneal bladder rupture. We sought to explore the possibility of nonoperative treatment of isolated intraperitoneal bladder rupture in children.
Eight children (4 girls and 4 boys) with a mean age of 6.3 +/- 4.6 years (range 1 to 13) presented with isolated posttraumatic intraperitoneal bladder rupture between 1993 and 2003. Retrograde cystogram was performed in all cases. Diagnosis was confirmed by aspiration and chemical analysis of the free intraperitoneal fluid in patients with an equivocal cystogram. Four patients who presented early in the series (group 1) were treated with the classic open repair, whereas the last 4 patients (group 2) were treated nonoperatively with adequate bladder drainage and percutaneous intraperitoneal tube drain. The mechanisms of injury, clinical presentation, management, complication, hospital stay and duration of catheterization were reviewed in both groups.
Six patients had a history of a direct blow to the full bladder, while 2 presented following a motor vehicle accident. All patients presented with vomiting and abdominal distention, and 5 had mild gross hematuria without associated clots or hemodynamic instability. One patient in group 1 had early urinary leakage and wound sepsis, and was treated conservatively. All patients in group 2 demonstrated significant improvement in general condition within a few hours of the bladder and peritoneal drainage. Intraperitoneal tube drains were removed at 1 to 4 days. There were no post-intervention complications in group 2 and surgical treatment was never required. Mean indwelling catheter duration was 9.3 +/- 7.9 and 11.8 +/- 2.6 days (p = 0.24), and mean hospital stay was 10.5 +/- 8.4 and 7.3 +/- 3.9 days (p = 0.56) in groups 1 and 2, respectively.
Nonoperative treatment is a justified initial approach for isolated intraperitoneal bladder rupture in children. Indications for surgical intervention include improper bladder drainage, unduly prolonged urinary drainage through the peritoneal drain and/or lack of clinical improvement.
开放性手术修复一直是治疗腹膜内膀胱破裂的标准方法。我们试图探讨儿童孤立性腹膜内膀胱破裂非手术治疗的可能性。
1993年至2003年间，8例（4例女孩，4例男孩）平均年龄6.3±4.6岁（范围1至13岁）的患儿出现孤立性创伤后腹膜内膀胱破裂。所有病例均行逆行膀胱造影。对于膀胱造影不明确的患者，通过抽吸和对腹腔内游离液体进行化学分析来确诊。该系列中早期就诊的4例患者（第1组）采用经典的开放性修复治疗，而最后4例患者（第2组）采用非手术治疗，即充分的膀胱引流和经皮腹腔置管引流。对两组患者的损伤机制、临床表现、治疗、并发症、住院时间和导尿持续时间进行了回顾。
6例患者有膀胱充盈时直接受撞击史，2例在机动车事故后就诊。所有患者均出现呕吐和腹胀，5例有轻度肉眼血尿，无相关血凝块或血流动力学不稳定。第1组1例患者早期出现尿漏和伤口感染，经保守治疗。第2组所有患者在膀胱和腹腔引流数小时内一般状况均有明显改善。腹腔引流管在1至4天拔除。第2组无干预后并发症，无需手术治疗。第1组和第2组的平均留置导尿时间分别为9.3±7.9天和11.8±2.6天（p = 0.24），平均住院时间分别为10.5±8.4天和7.3±3.9天（p = 0.56）。
非手术治疗是儿童孤立性腹膜内膀胱破裂合理的初始治疗方法。手术干预的指征包括膀胱引流不当、通过腹腔引流过度延长尿液引流时间和/或临床症状无改善。
