Frank M, Dedek T, Brod'ák M
Chirurgická klinika Lékarské fakulty Univerzity Karlovy a Fakultní nemocnice Hradec Králové.
Rozhl Chir. 2011 May;90(4):226-8.
The authors are presenting a case of 42-year-old polytraumatized man with pelvic fracture associated with extraperitoneal urinary bladder rupture. This was verified by intraoperative retrograde cystography and treated with suture without making suprapubic tube drainage. Urinary draining was assured with a transurethral permanent urinary catheter. Conversion from external fixation to internal osteosynthesis of pelvic fracture was performed as far as 26 days after admission for significantly poor overall condition of the patient. Injury of the bladder and pelvic fracture healed without any complications. This case review points to the possibility of surgical repair of bladder rupture without epicystostomy, which is an obstacle or an increased risk of infection for internal fixation of anterior part of the pelvic ring. Suprapubic tube is not beneficial in surgical repair of urinary bladder rupture. However, it is normal practice that the suprapubic tube associated with bladder suture is indicated according to urology department tradition or by an individual physician - urologist himself. In the choice of surgical treatment tactics in these types of injuries proper communication between the urologist and the surgeon dealing with complex pelvic trauma is important.
作者报告了一例42岁的多发伤男性患者,其骨盆骨折合并腹膜外膀胱破裂。术中逆行膀胱造影证实了这一情况,并采用缝合治疗,未进行耻骨上管引流。通过经尿道留置永久性导尿管确保尿液引流。由于患者整体状况极差,入院26天后才将骨盆骨折的外固定转换为内固定。膀胱损伤和骨盆骨折均愈合,无任何并发症。本病例回顾指出,膀胱破裂可不进行膀胱造瘘术而进行手术修复,膀胱造瘘术是骨盆环前部内固定的障碍或感染风险增加的因素。耻骨上管对膀胱破裂的手术修复并无益处。然而,根据泌尿外科传统或泌尿外科医生个人的判断,耻骨上管与膀胱缝合联合使用是常规做法。在这类损伤的手术治疗策略选择中,泌尿外科医生与处理复杂骨盆创伤的外科医生之间进行适当沟通很重要。