Fangmann Laura-Christin, Henrich Wolfgang, Hinkson Larry
Department of Obstetrics, Charité University Hospital, Berlin, Germany.
AJOG Glob Rep. 2022 Nov 25;3(1):100138. doi: 10.1016/j.xagr.2022.100138. eCollection 2023 Feb.
Bladder injury is a rare but serious complication that can occur during cesarean deliveries with an incidence of between 0.25% and 0.9%. Most bladder injuries (53%) occur upon entering the peritoneal cavity as a consequence of either extensive adhesions, a distorted pelvic anatomy, or an unexpectedly high-situated bladder owing to previous operations including a previous cesarean delivery. Patients with a previous abdominal operation can benefit from a preoperative ultrasound to identify the upper limits of an unexpectedly enlarged urinary bladder, even after preoperative catheterization. A modified surgical approach can then be applied to allow entry into the peritoneum above the bladder, thus preventing severe bladder injury. Surgeons may consider the use of preoperative sonography before operating on women with a previous abdominal surgery, especially following midline incisions, to improve safety and to potentially modify abdominal entry into the peritoneal cavity to avoid bladder injury.
膀胱损伤是剖宫产术中罕见但严重的并发症，发生率在0.25%至0.9%之间。大多数膀胱损伤（53%）发生在进入腹腔时，原因包括广泛粘连、骨盆解剖结构变形或由于既往手术（包括既往剖宫产）导致膀胱位置异常升高。既往有腹部手术史的患者，即使术前已留置导尿管，术前超声检查有助于识别意外增大的膀胱上限。然后可采用改良手术方法，在膀胱上方进入腹腔，从而预防严重膀胱损伤。对于有腹部手术史的女性，尤其是经中线切口手术的患者，外科医生在手术前可考虑使用术前超声检查，以提高安全性，并可能调整进入腹腔的方式以避免膀胱损伤。
