Tarney Christopher M
Womack Army Medical Center, Department of Obstetrics and Gynecology, 2817 Reilly Road, Fort Bragg, NC 28307, USA.
Curr Womens Health Rev. 2013 May;9(2):70-76. doi: 10.2174/157340480902140102151729.
Cesarean section is the most common surgery performed in the United States with over 30% of deliveries occurring via this route. This number is likely to increase given decreasing rates of vaginal birth after cesarean section (VBAC) and primary cesarean delivery on maternal request, which carries the inherent risk for intraoperative complications. Urologic injury is the most common injury at the time of either obstetric or gynecologic surgery, with the bladder being the most frequent organ damaged. Risk factors for bladder injury during cesarean section include previous cesarean delivery, adhesions, emergent cesarean delivery, and cesarean section performed at the time of the second stage of labor. Fortunately, most bladder injuries are recognized at the time of surgery, which is important, as quick recognition and repair are associated with a significant reduction in patient mortality. Although cesarean delivery is a cornerstone of obstetrics, there is a paucity of data in the literature either supporting or refuting specific techniques that are performed today. There is evidence to support double-layer closure of the hysterotomy, the routine use of adhesive barriers, and performing a Pfannenstiel skin incision versus a vertical midline subumbilical incision to decrease the risk for bladder injury during cesarean section. There is also no evidence that supports the creation of a bladder flap, although routinely performed during cesarean section, as a method to reduce the risk of bladder injury. Finally, more research is needed to determine if indwelling catheterization, exteriorization of the uterus, and methods to extend hysterotomy incision lead to bladder injury.
剖宫产是美国最常见的手术，超过30%的分娩通过这种方式进行。鉴于剖宫产术后阴道分娩（VBAC）率下降以及因产妇要求进行的初次剖宫产分娩率下降，而这会带来术中并发症的固有风险，这个数字可能会上升。泌尿外科损伤是产科或妇科手术中最常见的损伤，膀胱是最常受损的器官。剖宫产时膀胱损伤的危险因素包括既往剖宫产史、粘连、急诊剖宫产以及在第二产程时进行的剖宫产。幸运的是，大多数膀胱损伤在手术时就能被发现，这很重要，因为快速识别和修复与患者死亡率的显著降低相关。虽然剖宫产是产科的基石，但文献中缺乏支持或反驳当今所采用的特定技术的数据。有证据支持子宫切口双层缝合、常规使用粘连屏障以及采用耻骨联合上皮肤切口而非脐下正中垂直切口以降低剖宫产时膀胱损伤的风险。也没有证据支持创建膀胱瓣作为降低膀胱损伤风险的方法，尽管在剖宫产时常规进行。最后，需要更多研究来确定留置导尿、子宫外置以及延长子宫切口的方法是否会导致膀胱损伤。
