198例肾损伤的诊断与治疗

Diagnosis and treatment of renal trauma in 198 cases

目的探讨总结198例肾损伤的诊断及治疗方法。方法本组均行B超、CT、静脉尿路造影(IVU)和数字减影血管造影(DSA)检查,阳性率分别为92.1%,96.4%,70.5%和77.8%;非手术治愈145例;手术治愈52例,其中肾切除29例,肾修补术8例,肾静脉修补术3例,肾部分切除2例,肾动脉栓塞术10例。结果死亡1例(0.5%),197例痊愈出院(99.5%)。结论B超检查具有简单、快速、无损伤、不受病人条件限制等优点,应作为肾损伤的首选检查方法。CT检查准确率高,可判断肾损伤程度。DSA适宜诊断肾蒂伤,及肾动脉栓塞治疗。选择性肾动脉栓塞治疗肾挫伤安全有效,对严重肾损伤和开放性肾损伤应及时手术探查。

Objective To sum up the experience of diagnosis and treatment of renal trauma in 198 cases. Methods Large dose excretary urogram revealed abnormal findings in 70.5% cases examined. The positive rate of renal injury detected by B - ultrasonography, CT and DSA were 92.1% ,96.4 % and 77.8% respectively. One hundred and forty - five cases were managed conservatively and 52 cases were treated by operation. Nephrectomy, neoplasty of kidney . venous neoplasty of kidney, partial renal excision and embolization of renal vessels was carried out in 29,8,3,2 and 10 cases respectively. Results One patient died of coexistant cerebral trauma. One hundred and ninety - seven cases have been cured （99.5 %）. Conclusion B-ultrasonography which was simple, reliable and harmless to the patients , is the first choice in detecting renal trauma. Accurate diagnosis rate is high with CT scanning. DSA was applicable in diagnosis of injury of renal pedicle and treatment of embolization of renal artery. The treatment with embolization of renal vessels is safe and effective for the patients with contusion of kidney. Operative management in time is indicated in cases of severe injury and open renal injury.