不同膀胱异物的手术方式： 2 例报告

Surgical approaches to different foreign bodies in the urinary bladder ：A report of 2 cases

摘要

回顾 2 例膀胱异物的患者临床资料。由于异物的大小和类型不同，采用了不同的手术方式。病例1为21岁的男性患者，因尿痛于康复大学青岛中心医院就诊，患者自述2天前自行将一异物通过尿道插入体内，查体提示耻骨上疼痛，以膀胱异物收人泌尿外科。盆腔 CT 检查显示膀胱内有一长4.2 cm 的长条状金属异物，经过评估膀胱异物的形状和体积，考虑行膀胱镜检查以取出异物。患者于全身麻醉状态下，取截石位，直视下硬质膀胱镜进人膀胱，观察到膀胱内一金属管状结构异物。尝试使用异物夹将其取出，调整异物的长轴与膀胱镜平行。由于金属异物表面光滑，经过多次尝试后终于成功将异物取出。病例2为42岁男性患者，因排尿困难和尿痛于我院门诊就诊，并被收入泌尿外科。患者自述1天前自行将异物经尿道插入体内。泌尿系统 CT 检查提示膀胱内有一根金属管状结构异物，长度为 21.5 cm。考虑到异物较长（从髂䛝顶部至会阴部），且两端尖锐，不能排除膀胱穿孔可能；加之异物表面光滑，通过膀胱镜取出难度较大，且会增加医源性膀胱穿孔的风险，最终决定采用腹腔镜手术探查是否存在膀胱穿孔并取出异物。在全身麻醉下，患者取仰卧位，于脐上做 1 cm 切口，使用气腹针建立气腹，维持二氧化碳气腹压力 12 mmHg ；于脐下进入腹腔后，插入 10 mm Trocar 和腹腔镜，在左腹直肌外侧缘脐下 2 cm 处插入5 mm Trocar，在右腹直肌对称位置插入 12 mm Trocar；于腹腔镜下可见异物将膀胱顶部顶入腹腔，切开膀胱壁暴露异物，从会阴部向头端推挤异物，并通过脐上 Trocar 取出异物。

Abstract

We reported the clinical records of 2 patients each with a foreign body in the urinary bladder admitted to Qingdao Central Hospital，University of Health and Rehabilitation Sciences.The size and shape of each foreign body in the urinary bladder were different，thus we chose different surgical approa- ches to remove them.Case 1 was a 21 -year-old male patient.He presented to the outpatient service with urodynia.The patient currently complained of urodynia，and narrated that a foreign body was self- inserted via the urethra 2 days before.Physical examination revealed suprapubic pain.Ultimately he was admitted to the Department of Urology with a diagnosis of＂bladder foreign body＂.A computed tomography （CT）scan of the pelvis was performed and the results demonstrated a linear metallic structure，mea- suring 4.2 cm in length，within the urinary bladder.Under general anesthesia，the patient was placed in lithotomy position and a rigid cystoscope was inserted into the bladder via urethra.The foreign body was a metal tubular structure and was located within the urinary bladder.Removal by foreign body forceps was attempted and long axis of the foreign body should be parallel to cystoscope.Removal was carefully per- formed after several attempts due to the smooth surface of the metal foreign body.Case 2 was a 42 -year- old male patient.He presented to the outpatient service with dysuria and urodynia and was admitted to the Department of Urology.The patient narrated that a foreign body was self-inserted via the urethra 1 day before，and currently complained of dysuria，urodynia，and slight hematuria.A CT scan of the urologic system was performed and the results demonstrated a metal tubular structure，measuring 21.5 cm in length.The length of the foreign body was long（from top of iliac crest to perineum）and both ends were sharp，thus bladder perforation could not be excluded.Besides，with smooth metal surface，it was diffi- cult to remove via cystoscopy and the risk of iatrogenic bladder perforation would increase simultaneously. Therefore，laparoscopic surgery was chosen to detect whether there would be a bladder perforation and could remove the foreign body.Under general anesthesia，the patient was placed in supine position and supraumbilical incision of 1 cm was performed.Pneumoperitoneum needle was used to establish a pneu-moperitoneum and insufflation CO₂ pressure was maintained at 12 mmHg.The peritoneum was accessed and a 10-mm trocar and laparoscopic camera were inserted.A 5-mm trocar was inserted at 2 cm below the umbilical level of lateral margin of left rectus abdominis muscle.While a 12-mm trocar was inserted at symmetrical site of his right rectus abdominis muscle.Under laparoscope，dome of the bladder was lif- ted into the abdominal cavity by the foreign body，then the bladder wall was incised to expose the foreign body.We pushed the bottom of the foreign body from the perineum extracorporally and removed the foreign body from the supraumbilicus trocar.

关键词

异物 / 膀胱 / 腹腔镜 / 膀胱镜

Key words

Foreign bodies / Urinary bladder / Laparoscopes / Cystoscopes

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