介入治疗Ⅲ级以上闭合性肾外伤32例分析

Interventional therapy Ⅲ magnitude analysis of 32 cases of closed renal trauma

目的分析选择性动脉栓塞治疗Ⅲ级以上闭合性肾外伤的临床疗效。方法2009年1月~2017年12月闭合性肾外伤病人126例,Ⅲ级以上肾外伤病人74例,根据收治时间不同将74例病人分成两组,传统组(2013年3月前)42例,采用传统方式治疗。介入组(2013年3月后)32例,采用介入栓塞治疗。比较两组血尿持续时间、输血量、肾切除率、非计划二次手术、住院费用、住院时间的差异。结果传统组血尿持续时间Ⅲ级(8.10±1.23)天、Ⅳ级(4.14±0.59)天、Ⅴ级(4.01±0.28)天,输血量(95.13±5.28)ml,肾切除率83.33%(35/42),非计划二次手术8例,住院费用(3.11±0.45)万元,住院时间(13.34±2.20)天。介入组血尿持续时间Ⅲ级(3.06±1.62)天、Ⅳ级(3.07±0.83)天、Ⅴ级(2.93±0.56)天,输血量(20.56±1.44)ml,无肾切除,非计划二次手术2例,住院费用(1.06±0.82)万元,住院时间(7.06±1.41)天。介入组住院费用、住院时间优于传统组,差异有统计学意义(P<0.05);介入组血尿持续时间、输血量、肾切除率、非计划二次手术与传统组比传统组有明显优势,差异有统计学意义(P<0.05)。结论选择性肾动脉栓塞治疗Ⅲ级以上肾外伤较传统手术方式有明显优势,病人基础条件要求低,手术准备时间短、止血快、安全性高和可重复性,肾切除率低。

Objective To analyze the clinical efficacy of selective arterial embolization in the treatment of grade III and above closed renal trauma and to explore its application value.Methods Collected from January 2009 to December 2017,126 cases of closed renal trauma patients,Ⅲlevel more than 74 cases of renal trauma patients,according to different time were divided 74 patients into two groups,the traditional group(before March 2013)42 cases,adopts the traditional way of treatment.In the intervention group(after March 2013),32 patients were treated with interventional embolization.The differences in hematuria duration,blood transfusion volume,renal resection rate,unplanned secondary surgery,hospital expenses and hospital stay were compared between the two groups.Results Traditional group hematuria duration[Ⅲ(8.10±1.23)d,Ⅳ(4.14±0.59),Ⅴ(4.01±0.28)d],blood transfusion amount(95.13±5.28)for ml,renal resection rate 83.33%(35/42),8 cases of unplanned secondary surgery,hospitalization fee(3.11±0.45)ten thousand yuan,length of hospital stay(13.34±2.20)d.Duration of intervention group hematuria[Ⅲ(3.06±1.62)d,Ⅳ(3.07±0.83),Ⅴ(2.93±0.56)d],blood transfusion amount(20.56±1.44)ml,without renal resection,2 cases,hospitalization fee(1.06±0.82)ten thousand yuan,length of hospital stay(7.06±1.41)d.The cost and length of hospitalization in the intervention group were better than those in the traditional group,with statistically significant differences(P<0.05).The duration of hematuria,amount of blood transfusion,renal resection rate and unplanned secondary operation in the intervention group had significant advantages over the traditional group,with statistically significant differences(P<0.05).Conclusion Selective renal artery embolizationⅢmagnitude of renal trauma than traditional operation method has obvious advantages,the patient basic requirements is low,the operation preparation time is short,fast hemostasis,high safety and repeatability,renal resection rate is low.