Rosen M A, Light J K
Scott Department of Urology, Baylor College of Medicine, Houston, Texas.
J Urol. 1991 Nov;146(5):1232-4. doi: 10.1016/s0022-5347(17)38055-2.
Spontaneous bladder rupture following enterocystoplasty has been reported recently. The etiology remains unclear but appears to be multifactorial. The common factors among the reported patients are a high outlet resistance with total urinary continence and the presence of an augmented, dysfunctional native bladder. This combination may result in the development of high intravesical pressures or increased wall tension through several mechanisms, including over-filling and active contraction in the bowel or detrusor. The presence of an abnormal detrusor may cause the wall tension to be unevenly distributed toward the bowel segment. Diagnosis requires a high degree of suspicion and prompt laparotomy with closure of the defect. Prevention depends on maintaining low bladder volumes and, thus, pressures.
最近有报道称回肠膀胱扩大术后发生自发性膀胱破裂。病因尚不清楚，但似乎是多因素的。报告病例中的常见因素是高出口阻力伴完全尿失禁以及存在增大的、功能失调的原生膀胱。这种组合可能通过多种机制导致膀胱内压升高或壁张力增加，包括过度充盈以及肠道或逼尿肌的主动收缩。异常逼尿肌的存在可能导致壁张力朝着肠段不均匀分布。诊断需要高度怀疑并及时进行剖腹手术以封闭缺损。预防取决于维持低膀胱容量，从而降低压力。
