钝性力致膀胱损伤的处理：东部创伤外科学会的实践管理指南。
Management of blunt force bladder injuries: A practice management guideline from the Eastern Association for the Surgery of Trauma.
机构信息
From the Department of Urology (L.L.Y.), College of Medicine, University of Florida, Gainesville, Florida; Department of Surgery (A.A.M), Cleveland VAMC, Case Western Reserve University; Department of Surgery (J.J.C.), MetroHealth Medical Center, Cleveland, Ohio; Department of Surgery (B.R.), Harborview Medical Center, University of Washington, Seattle, Washington; Department of Surgery (J.K.), West Virginia University, Morgantown, West Virginia; Department of Surgery (M.A.P.), University of South Dakota, Sanford School of Medicine, Vermillion, South Dakota; Department of Surgery (J.K.L.), University of Illinois at Chicago, Illinois; and Department of Urology (P.D.), Minneapolis VAMC, University of Minnesota, Minneapolis, Minnesota.
出版信息
J Trauma Acute Care Surg. 2019 Feb;86(2):326-336. doi: 10.1097/TA.0000000000002132.
BACKGROUND
The diagnostic evaluation and clinical management of bladder injuries caused by blunt force trauma are variable. We aim to formulate a practice management guideline using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.
METHODS
The working group, patient, intervention, comparator, outcome (PICO), formulated four questions regarding the following topics: (1) diagnostic evaluation based on patient baseline risk of bladder injury (computed tomography cystography vs. no imaging); (2) management of intraperitoneal bladder injuries (operative versus nonoperative); (3) management of extraperitoneal bladder injuries based on complexity of injury (operative vs. nonoperative); and (4) diagnostic follow-up of bladder injuries based on complexity of repair (cystography vs. no cystography). A systematic review of the MEDLINE database for English language articles with adult patients was undertaken. RevMan 5 (Review Manager (RevMan) [Computer program]. Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014) and GRADEpro (GRADEpro GDT: GRADEpro Guideline Development Tool [Software]. McMaster University, 2015) software were used. Recommendations were voted on by working group members. Consensus was obtained for each recommendation.
RESULTS
Three hundred ninety-three articles were screened, resulting in a full-text review of 64 articles. Seventeen articles were used to formulate the recommendations of this guideline. Several recommendations are made. The need for initial computed tomography cystography after trauma depends on characteristics of the trauma itself, but it is not recommended in patients without gross hematuria. In general, patients with intraperitoneal bladder ruptures should undergo operative repair. This is not routinely necessary in those with extraperitoneal ruptures unless the injury is complex. The need for follow-up cystography after bladder repair depends on the risk of urine leak. Those with low risk of urine leak do not require a follow-up study.
CONCLUSION
Using the GRADE process, the panel made nine recommendations based on four PICO questions concerning the evaluation and management of blunt force bladder injuries.
背景
钝性创伤导致的膀胱损伤的诊断评估和临床处理方法多种多样。我们旨在使用推荐评估、制定与评价（GRADE）方法制定实践管理指南。
方法
工作组、患者、干预措施、对照、结局（PICO）制定了四个问题，涉及以下主题：（1）基于膀胱损伤的患者基线风险的诊断评估（计算机断层扫描膀胱造影与无影像学检查）；（2）腹腔内膀胱损伤的处理（手术与非手术）；（3）根据损伤复杂性的腹膜外膀胱损伤的处理（手术与非手术）；（4）根据修复复杂性的膀胱损伤的诊断随访（膀胱造影与无膀胱造影）。对 MEDLINE 数据库中以成年患者为对象的英文文献进行了系统回顾。使用 RevMan 5（Review Manager（RevMan）[计算机程序]。第 5.3 版。哥本哈根：北欧 Cochrane 中心，Cochrane 协作网，2014 年）和 GRADEpro（GRADEpro GDT：GRADEpro 指南制定工具[软件]。麦克马斯特大学，2015 年）软件进行推荐。工作组的成员对推荐进行投票。为每项推荐获得了共识。
结果
筛选了 393 篇文章，对 64 篇文章进行了全文审查。有 17 篇文章被用于制定本指南的推荐意见。提出了几项建议。创伤后初始进行 CT 膀胱造影取决于创伤本身的特征，但对于没有肉眼血尿的患者不建议进行。一般来说，有腹腔内膀胱破裂的患者应进行手术修复。除非损伤复杂，否则对于腹膜外破裂的患者一般不需要常规进行手术修复。膀胱修复后进行膀胱造影随访的需要取决于尿漏的风险。那些低漏尿风险的患者不需要进行后续研究。
结论
使用 GRADE 过程，根据四个 PICO 问题对钝性膀胱损伤的评估和处理，小组提出了 9 项建议。
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