J Trauma Acute Care Surg. 2013 Dec;75(6):1019-23. doi: 10.1097/TA.0b013e318299b61a.
The value of routinely testing bladder repair integrity with a cystogram before urinary catheter removal is unclear. The purpose of this study was to prospectively evaluate the utility of routine postoperative cystogram after traumatic bladder injury.
All patients sustaining a bladder injury requiring operative repair at two Level I trauma centers were prospectively enrolled during a 62-month study period ending on January 2011. Injury demographics, imaging data, and outcomes were extracted. All patients were evaluated with either a plain or a computed tomography cystogram.
A total of 127 patients were enrolled (mean [SD] age, 30.4 [13.5] years; blunt trauma, 63.8%, mean [SD] Injury Severity Score [ISS], 17.7 [10.6]). A total of 75 patients (59.1%) had an intraperitoneal (IP) bladder injury, 44 (34.6%) had an extraperitoneal (EP) bladder injury, and 8 had a (6.3%) combined IP/EP bladder injury. All patients with IP and IP/EP injuries (n = 83) underwent operative repair and a postoperative cystogram at 8.6 (1.8) days (range, 5-13 days). Sixty-nine IP injuries (83.1%) were simple (dome or body disruption/penetrating injury), while 14 (16.9%) were complex (trigone/requiring ureter implantation). There were no deaths during the follow-up period. With the exception of one patient (1.2%) with a complex injury requiring ureteric implantation, there were no leaks demonstrated on postoperative cystogram, and the urinary catheters were successfully removed.
In this prospective evaluation of the role of bladder evaluation after operative repair, routine use of follow-up cystograms for simple injuries did not impact clinical management. For complex repairs to the trigone or those requiring ureter implantation, a follow-up cystogram should be obtained before catheter removal.
Diagnostic study, level II.
在拔除导尿管之前，通过膀胱造影术常规检测膀胱修复完整性的价值尚不清楚。本研究的目的是前瞻性评估外伤性膀胱损伤术后常规行膀胱造影术的作用。
在 2011 年 1 月结束的 62 个月的研究期间，前瞻性招募了在两个一级创伤中心接受手术修复的所有膀胱损伤患者。提取损伤人口统计学、影像学数据和结局。所有患者均接受了单纯或计算机断层扫描膀胱造影术。
共纳入 127 例患者（平均[标准差]年龄为 30.4[13.5]岁；钝性创伤占 63.8%，平均[标准差]损伤严重程度评分[ISS]为 17.7[10.6]）。75 例（59.1%）患者有腹腔内（IP）膀胱损伤，44 例（34.6%）有腹膜外（EP）膀胱损伤，8 例（6.3%）有 IP/EP 联合膀胱损伤。所有有 IP 和 IP/EP 损伤的患者（n=83）均接受了手术修复和术后 8.6（1.8）天（5-13 天）的膀胱造影术。69 例 IP 损伤（83.1%）为单纯性（穹窿或体部破裂/穿透性损伤），14 例（16.9%）为复杂性（三角区/需要输尿管植入）。随访期间无死亡病例。除 1 例（1.2%）复杂性损伤需要输尿管植入外，术后膀胱造影术均未显示漏尿，且成功拔除导尿管。
在本前瞻性评估手术修复后膀胱评估作用的研究中，对于单纯性损伤，常规使用后续膀胱造影术并未影响临床处理。对于三角区的复杂性损伤或需要输尿管植入的损伤，应在拔除导尿管前获得后续膀胱造影术。
诊断性研究，II 级。
