膀胱損傷の臨床的検討

Abstract

膀胱損傷15例(男9例・女6例, 17～69歳)を対象に損傷原因, 損傷形式, 症状, 検査所見, 診断, 治療法などについて検討した.原因は外傷性損傷10例, 自然損傷5例で, 飲酒状態で受傷した症例が外傷性損傷で6例と高率に認められた.損傷形式は腹膜内損傷9例, 腹膜外損傷6例, 破裂部位は膀胱頂部9例, 前壁5例, 後壁1例であった.肉眼的血尿は9例, 腹痛は9例, 尿閉は4例でみられた.また, 腹膜内損傷10例中4例に, 血中のBUN, Cr上昇を認めた.初期診断で膀胱損傷が疑われたのは7例(46.7%)であった.診断法は膀胱造影6例, 膀胱鏡3例, CT2例, 超音波検査1例であった.合併損傷は外傷性の4例認め, 骨盤骨折が多かった.治療法は開腹による損傷部位の縫合閉鎖11例, 経尿道的留置カテーテル2例であった

Since bladder injury has no specific clinical symptoms, accurate diagnosis at first consultation is relatively difficult. To elucidate the clinical characters type of injury, clinical symptoms, laboratory findings, methods of therapy and diagnosis, we reviewed 15 patients with bladder injury over a 9-year-period 1990-1998 (10 were traumatic injuries and 5 spontaneous injuries). We found no specific clinical symptom of bladder injury. Bladder injury may occur anywhere in the bladder wall, but most commonly occurred at the dome of the bladder (60.0%). Gross hematuria was not seen in 40.0% of the cases. The accuracy of diagnosis at first consultation was relatively low (46.7%) and the tendency to make a misdiagnosis as acute abdomen on digestive organs was found. Of the traumatic injuries 60% were afflicted in the drunken state, so alcohol intoxication was considered as an important enviromental factor of bladder injury. Surgical repair of injury sites was employed in 11 cases (73.3%: 7 were intraperitoneal injuries, 4 were extraperitoneal injuries), 4 cases were managed with indwelling urethral catheter. With appropriate treatment, the prognosis is excellent.