出血性放射性膀胱炎合并膀胱自发性破裂的诊治分析  

Diagnosis and treatment of hemorrhagic irradiation cystitis with spontaneous rupture of bladder

作　　者：熊云鹤[1,2] 张家彬[1,2] 刘昌明[1,2] 李惠长[1,2] 李国敏[1,2] 钱本江[1,2] 张茨[3] 申复进[3] 

机构地区：[1]福建医科大学闽东教学基地 [2]福建省宁德市闽东医院泌尿外科,福建宁德355000 [3]武汉大学人民医院泌尿外科,湖北武汉430060

出　　处：《中国现代医学杂志》2010年第6期886-888,共3页China Journal of Modern Medicine

摘　　要：目的探讨出血性放射性膀胱炎合并膀胱自发性破裂的临床特点和诊治方法。方法分析12例急诊膀胱破裂修补术后诊断为出血性放射性膀胱炎的临床资料、术后治疗手段和程序。结果 12例患者均存在盆腔放疗史,术前存在膀胱血块梗阻8例,有憋尿史4例。术中均发现膀胱壁广泛不规则增厚,病检提示膀胱慢性炎症。术后1～2周内,10例再发膀胱大量出血,给予膀胱灌注1%甲醛。3例治愈,7例因严重出血膀胱内血块引起排尿困难,给予电切镜下膀胱血块清除术加膀胱壁广泛电凝止血后,出血控制。术后给予高压氧治疗后治愈。近期2例于膀胱修补术后早期给予高压氧治疗,未发生再发出血。结论膀胱自发性破裂术中发现膀胱壁病变、有盆腔放疗史的患者,应高度怀疑出血性放射性膀胱炎的可能,术后再发膀胱出血率高,治疗可分步骤进行。术后早期给予高压氧治疗对预防再发出血是必要的。【Objective】TTo discuss the diagnosis and treatment of hemorrhagic irradiation cystitis with spontaneous ruptured bladder.【Methods】 The clinical data of 12 patients,who received emergency repair of ruptured bladder and were diagnosed as hemorrhagic irradiation cystitis postoperatively,were retrospectively reviewed.The clinical characteristics,treatment procedures and means were analyzed.【Results】 All 12 cases had the history of pelvic irradiation.Of which 8 patients had obstruction caused by bladder blood clot and 4 patients had the history of holding urine.The abroad and abnormal thickening of bladder wall was seen in all patients,biopsy results indicated chronic inflammation.Major hemorrhage of bladder recurred in 10 patients within 1-2 weeks after operation.Three cases were controlled after irrigation of bladder with 1% formaldehyde,7 patients received transurethral clot removing and extensive electric coagulation,then were treated with hyperbaric oxygen.Two recent patients who were administrated hyperbaric oxygen in early period after repair of bladder did not have bladder hemorrhage.【Conclu-sion】Hemorrhagic irradiation cystitis should be suspected when pathological changes of bladder wall are found in emergency repair of ruptured bladder and patients have the history of pelvic irradiation.The rate of recurring bladder hemorrhage is high.The treatment should be taken step by step.It is necessary to administrate hyperbaric oxygen as early as possible to prevent recurring bladder hemorrhage after operation.

关 键 词：放射性膀胱炎 膀胱破裂 诊断 治疗 

分 类 号：R694.3[医药卫生—泌尿科学]