279例肾损伤的诊治体会

An experience with 279 cases of renal trauma

目的:提高肾损伤的诊治效果.方法:回顾性分析279例肾损伤患者的临床诊治资料.结果:血尿260例(占93.2%);B超检查168例,其中122例(72.6%)有异常表现;CT检查76例,阳性表现63例(83.0%);静脉肾盂造影检查80例,其中肾穿透伤12例(占15.0%),肾钝性伤3例(占3.8%).本组患者手术治疗57例(20.4%),非手术治疗222例(79.6%).死亡10例(3.6%),治愈269例(96.4%).152例(54.5%)随访1～3年,尿常规及肾功能检查正常.结论:尿液检查和B超检查快速、安全、无损伤.对于有血尿的肾穿透伤患者,或虽无血尿但高度怀疑肾损伤的患者,如生命体征平稳,接受静脉肾盂造影检查是必要的.CT检查准确率高,可同时了解其他脏器受损程度.如果损伤严重,尤其是并发腹内脏器受损时,宜适时探查肾脏,做出相应的外科处理.

Objective:To present an experience with 279 cases of renal trauma.Methods:279 cases of renal trauma were retrospectively analysed.Results:Hematuria occurred in 260 cases ( 93.2%); aberrant findings were observed on ultrasonography in 122 out of 168 ( 72.6%) and on CT scan in 63 out of 70(90%); Intravenous pyelogram (IVP) was performed in 80 patients: abnormal images was obtained in 12 out of 16 patients with penetrating wounds and in 3 out of 64 cases with blunt injuries; 124 patients had injuries of other organs; open operation was undertaken in 57 and 222 were treated nonoperatively. 10 ( 2.2%) died of shock and coexistant injuries of other organs, the other 269 have been cared, 152 of which have been followed up for 1～3 years with normal urine routine and renal function.Conclusions:Urine inspection and B-ultrasonography were simple、 instant、 reliable and harmless to the patient; The intravenous pyelogram is essential to the patients with hematuria and to the higly suspected cases though without hematuria. The diagnostic rate of CT scanning is high, which is also helpful in detecting any coexistant injuries. Surgical management is indicated in cases of severe injuries, particularly, if there are other coexisting injuries of abdomen. When hematuria is getting more severe and the shock of bleeding would be inevitable, the patients should receive operation in time.