Urry R J, Clarke D L, Bruce J L, Laing G L
Department of Urology, Greys Hospital, Pietermaritzburg, South Africa; School of Clinical Medicine, University of KwaZulu-Natal, Nelson R Mandela School of Medicine, South Africa.
Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg Metropolitan Hospitals Complex, Pietermaritzburg, South Africa; School of Clinical Medicine, University of KwaZulu-Natal, Nelson R Mandela School of Medicine, South Africa.
Injury. 2016 May;47(5):1057-63. doi: 10.1016/j.injury.2016.01.020. Epub 2016 Jan 25.
The purpose of this study is to provide a comprehensive overview of the incidence, spectrum and outcomes of traumatic bladder injury in Pietermaritzburg, South Africa, and to identify the current optimal investigation and management of patients with traumatic bladder injuries.
The Pietermaritzburg Metropolitan Trauma Service (PMTS) trauma registry was interrogated retrospectively for all traumatic bladder injuries between 1 January 2012 and 31 October 2014.
Of 8129 patients treated by the PMTS over the study period, 58 patients (0.7% or 6.5 cases per 1,000,000 population per year) had bladder injuries, 65% caused by penetrating trauma and 35% by blunt trauma. The majority (60%) were intraperitoneal bladder ruptures (IBRs), followed by 22% extraperitoneal bladder ruptures (EBRs). There was a high rate of associated injury, with blunt trauma being associated with pelvic fracture and penetrating trauma being associated with rectum and small intestine injuries. The mortality rate was 5%. Most bladder injuries were diagnosed at surgery or by computed tomography (CT) scan. All IBRs were managed operatively, as well as 38% of EBRs; the remaining EBRs were managed by catheter drainage and observation. In the majority of operative repairs, the bladder was closed in two layers, and was drained with only a urethral catheter. Most patients (91%) were managed definitively by the surgeons on the trauma service.
Traumatic bladder rupture caused by blunt or penetrating trauma is rare and mortality is due to associated injuries. CT scan is the investigative modality of choice. In our environment IBR is more common than EBR and requires operative management. Most EBRs can be managed non-operatively, and then require routine follow-up cystography. Simple traumatic bladder injuries can be managed definitively by trauma surgeons. A dedicated urological surgeon should be consulted for complex injuries.
本研究旨在全面概述南非彼得马里茨堡创伤性膀胱损伤的发病率、范围及治疗结果，并确定目前对创伤性膀胱损伤患者的最佳检查方法和治疗措施。
对彼得马里茨堡市创伤服务中心（PMTS）2012年1月1日至2014年10月31日期间所有创伤性膀胱损伤病例进行回顾性调查。
在研究期间接受PMTS治疗的8129例患者中，有58例（0.7%，即每年每百万人口中有6.5例）发生膀胱损伤，其中65%由穿透性创伤引起，35%由钝性创伤引起。大多数（60%）为腹膜内膀胱破裂（IBRs），其次是22%的腹膜外膀胱破裂（EBRs）。合并损伤发生率较高，钝性创伤常合并骨盆骨折，穿透性创伤常合并直肠和小肠损伤。死亡率为5%。大多数膀胱损伤在手术中或通过计算机断层扫描（CT）确诊。所有IBRs均通过手术治疗，38%的EBRs也通过手术治疗；其余EBRs通过导管引流和观察进行治疗。在大多数手术修复中，膀胱采用两层缝合，并仅通过尿道导管引流。大多数患者（91%）由创伤服务中心的外科医生进行明确治疗。
钝性或穿透性创伤导致的创伤性膀胱破裂很少见，死亡率主要归因于合并损伤。CT扫描是首选的检查方式。在我们的环境中，IBRs比EBRs更常见，需要手术治疗。大多数EBRs可以非手术治疗，随后需要进行常规的膀胱造影随访。简单的创伤性膀胱损伤可由创伤外科医生进行明确治疗。对于复杂损伤，应咨询专业的泌尿外科医生。
