膀(bang)(bang)(bang)(bang)胱(guang)(guang)(guang)(guang)(guang)(guang)是(shi)貯存、排(pai)泄尿(niao)液的器官(guan)。隨(sui)(sui)著貯存尿(niao)液的多(duo)少而呈膨起(qi)或空(kong)虛。在(zai)嬰兒(er)兒(er)童時(shi)期,膀(bang)(bang)(bang)(bang)胱(guang)(guang)(guang)(guang)(guang)(guang)高(gao)出(chu)于恥(chi)骨弓(gong)而位于下(xia)(xia)腹(fu)(fu)部(bu)(bu)。在(zai)成(cheng)年男(nan)(nan)性(xing)(xing),膀(bang)(bang)(bang)(bang)胱(guang)(guang)(guang)(guang)(guang)(guang)介于恥(chi)骨與(yu)直腸之間(jian)。其(qi)下(xia)(xia)與(yu)前列腺(xian)部(bu)(bu)尿(niao)道相通,后(hou)面為(wei)精囊(nang)和輸精管(guan)壺腹(fu)(fu)部(bu)(bu)。膀(bang)(bang)(bang)(bang)胱(guang)(guang)(guang)(guang)(guang)(guang)與(yu)直腸之間(jian)是(shi)直腸膀(bang)(bang)(bang)(bang)胱(guang)(guang)(guang)(guang)(guang)(guang)陷凹(ao)。女性(xing)(xing)膀(bang)(bang)(bang)(bang)胱(guang)(guang)(guang)(guang)(guang)(guang)之后(hou)方為(wei)子宮(gong),兩者(zhe)(zhe)之間(jian)是(shi)子宮(gong)膀(bang)(bang)(bang)(bang)胱(guang)(guang)(guang)(guang)(guang)(guang)陷凹(ao)。故(gu)女性(xing)(xing)膀(bang)(bang)(bang)(bang)胱(guang)(guang)(guang)(guang)(guang)(guang)的位置較(jiao)男(nan)(nan)性(xing)(xing)為(wei)靠前和較(jiao)低,而覆(fu)蓋(gai)于膀(bang)(bang)(bang)(bang)胱(guang)(guang)(guang)(guang)(guang)(guang)后(hou)壁的腹(fu)(fu)膜反折,因與(yu)子宮(gong)相連,故(gu)較(jiao)男(nan)(nan)性(xing)(xing)者(zhe)(zhe)為(wei)高(gao)。臍尿(niao)管(guan)以下(xia)(xia)的膀(bang)(bang)(bang)(bang)胱(guang)(guang)(guang)(guang)(guang)(guang)壁直接與(yu)腹(fu)(fu)前壁相接觸(chu),其(qi)間(jian)無腹(fu)(fu)膜覆(fu)蓋(gai)。故(gu)膀(bang)(bang)(bang)(bang)胱(guang)(guang)(guang)(guang)(guang)(guang)空(kong)虛時(shi),僅(jin)在(zai)其(qi)上(shang)(shang)緣為(wei)腹(fu)(fu)膜遮蓋(gai),膀(bang)(bang)(bang)(bang)胱(guang)(guang)(guang)(guang)(guang)(guang)的前下(xia)(xia)方和側(ce)壁下(xia)(xia)面的部(bu)(bu)分側(ce)無腹(fu)(fu)膜遮蓋(gai)。當膀(bang)(bang)(bang)(bang)胱(guang)(guang)(guang)(guang)(guang)(guang)充(chong)盈(ying)膨脹(zhang)時(shi),膀(bang)(bang)(bang)(bang)胱(guang)(guang)(guang)(guang)(guang)(guang)上(shang)(shang)升到腹(fu)(fu)下(xia)(xia)部(bu)(bu),覆(fu)蓋(gai)于膀(bang)(bang)(bang)(bang)胱(guang)(guang)(guang)(guang)(guang)(guang)頂部(bu)(bu)的腹(fu)(fu)膜也隨(sui)(sui)之升高(gao)。可(ke)見膀(bang)(bang)(bang)(bang)胱(guang)(guang)(guang)(guang)(guang)(guang)的位置,與(yu)周圍(wei)臟器的關系(xi)可(ke)因年齡(ling)、性(xing)(xing)別和尿(niao)液充(chong)盈(ying)程度不同而異。膀(bang)(bang)(bang)(bang)胱(guang)(guang)(guang)(guang)(guang)(guang)這種(zhong)解剖和生理的特點與(yu)其(qi)損傷(shang)的類型、部(bu)(bu)位和范圍(wei)均(jun)有著密(mi)切的關系(xi)。
尿管。如病情危重,裂口近膀胱頸部而難以仔細縫合時,勿需勉強修補,作恥骨上膀胱造口術并徹底引流膀胱前間隙后,裂口可自行愈合。膀胱裂口修復后,留置保留導尿管1周左右后再拔除。如腹壁、腰部、坐骨直腸窩、會陰、陰囊甚至股部有尿外滲時,必須徹底切開引流以免繼發感染。2.腹膜(mo)(mo)內型膀(bang)胱破裂(lie):切開腹膜(mo)(mo),吸盡腹腔內的(de)液體,探查膀(bang)胱圓頂和后壁以確定裂(lie)口,同時可在(zai)腹膜(mo)(mo)反折下(xia)切開膀(bang)胱前(qian)(qian)壁并觀察膀(bang)胱內部(bu)。修復裂(lie)口后如無腹腔內臟損傷,即縫合腹膜(mo)(mo)。在(zai)膀(bang)胱前(qian)(qian)壁作一(yi)高(gao)位造瘺。并引流膀(bang)胱前(qian)(qian)間隙。
(三)晚期(qi)治療:主要是處理膀(bang)胱瘺(lou)(lou)(lou)(lou)(lou),必須待(dai)傷(shang)員一(yi)般情(qing)況(kuang)好轉和(he)(he)局部急(ji)性炎癥(zheng)消退(tui)后才可進(jin)(jin)行(xing)。長期(qi)膀(bang)胱瘺(lou)(lou)(lou)(lou)(lou)可使膀(bang)胱發(fa)生(sheng)嚴重感染和(he)(he)攣縮(suo),應(ying)采取相(xiang)當防治措(cuo)施(shi)。手術主要步驟是切除瘺(lou)(lou)(lou)(lou)(lou)管和(he)(he)瘺(lou)(lou)(lou)(lou)(lou)孔邊(bian)緣(yuan)的瘢痕組織,縫合瘺(lou)(lou)(lou)(lou)(lou)孔并作高(gao)位的恥骨(gu)上(shang)膀(bang)胱造瘺(lou)(lou)(lou)(lou)(lou)術。結腸造口應(ying)在(zai)膀(bang)胱直(zhi)腸瘺(lou)(lou)(lou)(lou)(lou)完全(quan)修(xiu)復愈合后才關閉。膀(bang)胱陰(yin)道(dao)瘺(lou)(lou)(lou)(lou)(lou)與(yu)膀(bang)胱子宮瘺(lou)(lou)(lou)(lou)(lou)應(ying)進(jin)(jin)行(xing)修(xiu)補,在(zai)恥骨(gu)上(shang)膀(bang)胱另造瘺(lou)(lou)(lou)(lou)(lou)口,并引(yin)流膀(bang)胱前(qian)間隙。
【保健貼士】
1、閉合性(xing)(xing)損傷:膀胱(guang)空虛(xu)時(shi)位于骨(gu)盆(pen)(pen)深(shen)處受(shou)到周圍組織保護,不易受(shou)外界暴(bao)力損傷。當膀胱(guang)膨脹時(shi),因(yin)膀胱(guang)擴張且高出(chu)恥骨(gu)聯合,下腹部受(shou)到暴(bao)力時(shi),如踢傷、擊(ji)傷和(he)跌傷等可造成(cheng)膀胱(guang)損傷,骨(gu)盆(pen)(pen)骨(gu)折(zhe)的(de)骨(gu)折(zhe)斷(duan)端可以刺破膀胱(guang);難(nan)產(chan)時(shi),胎頭長時(shi)間壓迫可造成(cheng)膀胱(guang)壁(bi)缺(que)血性(xing)(xing)壞死。
2、開放性損(sun)傷(shang):多見(jian)于火(huo)器(qi)傷(shang),常合(he)并骨盆內其他組織(zhi)器(qi)官(guan)的損(sun)傷(shang)。
3、手術損(sun)(sun)傷:膀(bang)胱(guang)鏡檢查(cha)(cha),尿道擴張等器械檢查(cha)(cha)可造成膀(bang)胱(guang)損(sun)(sun)傷。盆腔和下腹部手術,如疝修補(bu),婦科惡性腫瘤切除等易致膀(bang)胱(guang)損(sun)(sun)傷。
術后采取綜合療法(fa),使患者獲得充分(fen)休(xiu)息(xi),足夠營養(yang),適當水分(fen),糾正貧血,控制感染以(yi)期早日恢復。
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