Inaba Kenji, McKenney Mark, Munera Felipe, de Moya Marc, Lopez Peter P, Schulman Carl I, Habib Fahim A
Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 1200 North State Street 10-750, Los Angeles, CA 90033, USA.
J Trauma. 2006 Jan;60(1):23-8. doi: 10.1097/01.ta.0000200096.44452.8a.
The utility of obtaining a routine cystogram after the repair of intraperitoneal bladder disruption before urethral catheter removal is unknown. This study was designed to examine whether follow-up cystogram evaluation after traumatic bladder disruption affected the clinical management of these injuries. We hypothesized that routine cystograms, after operative repair of intraperitoneal bladder disruptions, provide no clinically useful information and may be eliminated in the management of these injuries.
Our prospectively collected trauma database was retrospectively reviewed for all ICD-9 867.0 and 867.1 coded bladder injuries over a 6-year period ending in June 2004. Demographics, clinical injury data, detailed operative records, and imaging studies were reviewed for each patient. Bladder injuries were categorized as intraperitoneal (IP) or extraperitoneal (EP) bladder disruptions based on imaging results and operative exploration. Patients with IP injuries were further subdivided into those with "simple" dome disruptions or through-and-through penetrating injuries and "complex" injuries involving the trigone or ureter reimplantation. All patients sustaining isolated ureteric or urethral injury were excluded from further analysis.
In all, 20,647 trauma patients were screened for bladder injury. Out of this group, there were 50 IP (47 simple, 3 complex) and 37 EP injuries available for analysis. All IP injuries underwent operative repair. Eight of the IP injuries (all simple) had no postoperative cystogram and all were doing well at 1- to 4-week follow-up. The remaining 42 patients underwent a postoperative cystogram at 15.3 +/- 7.3 days (range 7 to 36 days). All simple IP injuries had a negative postoperative cystogram. The only positive study was in one of the three complex IP injuries. In the EP group, 21.6% had positive cystograms requiring further follow-up and intervention.
Patients sustaining extraperitoneal and complex intraperitoneal bladder disruptions require routine cystogram follow-up. In those patients undergoing repair of a simple intraperitoneal bladder disruption, however, routine follow-up cystograms did not affect clinical management. Further prospective evaluation to determine the optimal timing of catheter removal in this patient population is warranted.
在拔除尿道导管前，对腹膜内膀胱破裂进行修复后常规行膀胱造影的作用尚不清楚。本研究旨在探讨创伤性膀胱破裂后行膀胱造影随访评估是否会影响这些损伤的临床处理。我们假设，腹膜内膀胱破裂手术修复后，常规膀胱造影并无临床有用信息，在这些损伤的处理中可以省去。
对我们前瞻性收集的创伤数据库进行回顾性分析，纳入2004年6月结束的6年期间所有ICD-9编码为867.0和867.1的膀胱损伤患者。对每位患者的人口统计学资料、临床损伤数据、详细手术记录和影像学检查进行审查。根据影像学结果和手术探查，将膀胱损伤分为腹膜内（IP）或腹膜外（EP）膀胱破裂。IP损伤患者进一步分为“单纯”穹窿部破裂或贯通性穿透伤以及涉及三角区或输尿管再植的“复杂”损伤。所有单纯输尿管或尿道损伤患者均排除在进一步分析之外。
总共筛查了20647例创伤患者的膀胱损伤。其中，有50例IP损伤（47例单纯性、3例复杂性）和37例EP损伤可供分析。所有IP损伤均接受了手术修复。8例IP损伤（均为单纯性）术后未行膀胱造影，1至4周随访时情况均良好。其余42例患者术后15.3±7.3天（范围7至36天）行膀胱造影。所有单纯IP损伤术后膀胱造影均为阴性。唯一阳性检查结果出现在3例复杂性IP损伤中的1例。在EP组中，21.6%的患者膀胱造影阳性，需要进一步随访和干预。
腹膜外和复杂性腹膜内膀胱破裂患者需要常规膀胱造影随访。然而，对于接受单纯腹膜内膀胱破裂修复的患者，常规随访膀胱造影并不影响临床处理。有必要进一步进行前瞻性评估，以确定该患者群体拔除导管的最佳时机。
