Danielle J Wilson, Isaac Melin, Nayan Shah, R Corey O'Connor, Thomas Carver
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引用次数: 0
摘要
摘要：导言：外伤性膀胱损伤虽然罕见，但可能导致患者严重发病。建议对腹膜内（IP）、混合性和部分腹膜外（EP）损伤进行手术治疗。目前的指南缺乏关于手术修复后导尿管持续时间的建议，并认为对于简单的修复性损伤可能不需要进行后续膀胱造影。这导致了我们医院在术后管理方面的实践差异。我们假设，与泌尿科相比，创伤外科的导尿时间更短，随访膀胱造影次数更少，但并发症不会增加：方法： 2010年1月至2022年12月期间，在一家一级创伤中心进行了回顾性研究。方法：2010 年 1 月至 2022 年 12 月期间，在一家一级创伤中心开展了一项回顾性研究，从创伤登记处纳入了这一时期内所有膀胱创伤患者。结果：在确定的 178 名患者中，有 86 名符合纳入标准。IP损伤最常见（43%），其次是EP损伤（31%）和混合损伤（26%）。尽管导尿管持续时间（11 天 vs 17 天，P=0.006）和术后膀胱造影使用率（77% vs 100%，P=0.006）存在差异，但无论由哪个团队进行修复，简单损伤修复后的患者预后均相似：简单膀胱修补术后导管引流和随访造影方面的管理差异导致了相似的漏尿率和并发症发生率。我们的研究结果为缩短术后导管引流时间和在简单修复术中使用膀胱造影提供了机会：证据级别：IV。
Investigating the timing of catheter removal after traumatic bladder injury: a single-institution 12-year experience.
Abstract:
Introduction: Traumatic bladder injuries, although rare, may result in significant patient morbidity. Operative management is recommended for intraperitoneal (IP), mixed, and select extraperitoneal (EP) injuries. Current guidelines lack recommendations on catheter duration following operative repair and suggest follow-up cystography may be unnecessary for simple, repaired injuries. This has led to practice variation in postoperative management at our institution. We hypothesized that the trauma surgery service would have a shorter catheter duration and obtain fewer follow-up cystograms compared with the urology service, without increased complications.
Methods: A retrospective review was conducted at a single level 1 trauma center between January 2010 and December 2022. All patients with traumatic bladder injuries during this period were included from the trauma registry. Those who were <18 years of age, lacked a full-thickness injury, died within 7 days of presentation, had a concomitant urethral injury or complex injury, did not undergo surgical repair, were lost to follow-up, underwent surgical management elsewhere, or had an iatrogenic injury were excluded. Data on patient demographics, management, and complications were recorded. Injuries were classified as complex when involving the trigone, ureters, or bladder neck, or were described as complex in the operative report.
Results: Of the 178 patients identified, 86 met the inclusion criteria. IP injuries were most common (43%), followed by EP (31%), and mixed (26%). Patient outcomes following the repair of simple injuries were similar regardless of the team performing the repair, although differences in catheter duration (11 days vs 17 days, p=0.006) and use of postoperative cystography (77% vs 100%, p<0.001) were observed (trauma vs urology, respectively).
Conclusion: Variations in postoperative management regarding catheter drainage and follow-up imaging for simple bladder repairs resulted in similar leak and complication rates. Our findings present an opportunity to reduce the duration of postoperative catheter drainage and cystography use in simple repairs.
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