肾脏损伤的诊断和治疗(附120例报告)

The diagnosis and management of renal injuries (reports of 120 cases)

回顾分析１９７５～１９９５年间收治的肾损伤患者１２０例，其中血尿１１６例，行大剂量ＩＶＵ检查７８例，有异常发现４５例；Ⅱ～Ⅳ级肾损伤ＩＶＵ阳性率为９５％；ＣＴ检查２０例，其中９例诊断为Ⅲ类肾损伤并经手术探查证实。对８１例Ⅰ、Ⅱ类肾损伤者行保守治疗，除１例随访发现高血压外其他患者无并发症；２例Ⅲ类肾损伤行保守治疗失败行肾切除，８例Ⅲ类肾损伤经选择性肾动脉栓塞治疗而痊愈；手术探查２８例，肾脏仅为挫伤者１０例，肾深度裂伤６例修复成功，１２例伤情重者行了肾切除。１２０例中除１例死亡外，其他患者治疗效果满意。结合文献。

From 1975 to 1995,120 cases of renal injury were treated.Hematuria was obvious in 116 while in the other 4 hematuria was totally absent.Large dose excretary urogram revealed abnormal findings in 45 of the 78 patients examined.In type Ⅱ to type Ⅳ renal injury,IVU revealed abnormal findings in 95% (20/21).The renal injury was evaluated by CT in 20 patients and in 9 of them type Ⅲ renal injury was detected and comfirmed on surgical exploration.81 patients with type Ⅰ and type Ⅱ renal injury were successfully treated conservatively while 1 patient has suffered from hypertension on follow up studies.Surgical exploration was conducted in 28 patients,in 10 of them there were concomitant intra abdominal injuries.Nephrectomy was carried out in 12 patients.Treatment has been successful in all except one who died of serious injuries.The diagnosis and management of renal injuries were discussed in detail with review of the literature.