膀胱穿刺術簡介與定義

簡單來說，膀胱穿刺術就是使用針頭經皮膚穿刺進入膀胱，直接抽取尿液的醫療程序。雖然聽起來有點可怕，但在某些情況下，它卻是診斷疾病不可或缺的重要技術。

為什麼需要膀胱穿刺術？

尿液樣本的重要性

收集尿液樣本是診斷許多疾病，特別是泌尿道感染的重要步驟。

傳統尿液收集方法的侷限性

然而，對於某些族群，例如還不會自行排尿的嬰幼兒，或是無法配合收集尿液的病人，取得乾淨、未受污染的尿液樣本就變得相當困難。傳統的尿液收集方法，例如使用尿袋或導尿管，容易受到外部細菌污染，影響檢驗結果的準確性。

膀胱穿刺術的優勢

而膀胱穿刺術可以直接從膀胱取得尿液，大幅降低污染的風險，提供更可靠的診斷依據。如同台灣的動物醫院，也越來越常使用膀胱穿刺術來收集尿液樣本，特別是在犬貓等寵物患有泌尿道問題時。台灣獸醫外科專科醫學會（機構說明）提醒，膀胱穿刺術不僅用於尿液分析、培養和藥敏試驗，也可用於減壓性膀胱穿刺術，幫助患有尿路結石或尿路阻塞的病人減輕不適感和降低膀胱壓力。

膀胱穿刺術的應用時機

根據美國小兒科學會的建議，以及文獻中提到的案例，膀胱穿刺術主要應用於以下情況：

診斷嬰幼兒泌尿道感染

對於六個月以下的嬰兒，由於難以取得未受污染的尿液樣本，膀胱穿刺術和導尿被認為是診斷泌尿道感染的標準方法。文獻中提到，導尿的污染率為8-14%，而膀胱穿刺術的污染率則更低，僅為1-9%。雖然膀胱穿刺術屬於侵入性操作，但相較於導尿，它能提供更準確的診斷結果。

其他需要取得無菌尿液樣本的情況

除了嬰幼兒泌尿道感染之外，在某些特殊情況下，例如需要進行特定尿液檢驗，或懷疑有特殊病原體感染時，也可能需要使用膀胱穿刺術來取得無菌的尿液樣本。

膀胱穿刺術的優缺點

其他尿液收集方法

除了膀胱穿刺術和導尿之外，還有其他一些尿液收集方法，例如：

清潔中段尿

指的是在排尿過程中，收集中間段的尿液。這種方法簡單易行，但容易受到外部細菌污染，不適用於需要無菌尿液樣本的情況。

尿袋收集

適用於嬰幼兒，但同樣容易受到污染，影響檢驗結果的準確性。

膀胱刺激法

這是一種非侵入性的尿液收集方法，通過刺激膀胱誘導排尿，再收集尿液樣本。目前的研究顯示，膀胱刺激法的污染率與導尿相近。

恥骨上膀胱造廔手術

在麻醉狀態下，在肚臍下方、恥骨上方切開約一公分開口，將導尿管直接插入膀胱，建立一個尿液引流通道。這種方法特別適用於急性尿液滯留、尿道阻塞或其他導尿管插入困難的情況，並可以減少長期經尿道置放導尿管所導致的併發症。

總結

膀胱穿刺術是一種在特定情況下，用於收集尿液樣本的重要醫療技術。它能有效降低污染風險，提供更準確的診斷依據，尤其適用於嬰幼兒泌尿道感染的診斷。然而，作為一種侵入性操作，膀胱穿刺術需要由專業人員執行，並權衡其利弊後再進行。

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