147例闭合性肾脏损伤诊治分析

An experience of determination and treatment of 147 cases with blunt, renal trauma

目的 探讨闭合性肾脏损伤诊断和治疗的方法。方法 对1999年8月～2005年4月收治的147例创伤性闭合性肾脏损伤临床病例资料进行回顾分析。结果 147例中出现血尿者136例（92．5％），合并休克者48例（32．7％）．伴有其他部位损伤者94例（63．9％）。全部病例均行CT检查明确损伤程度。保守治疗113例（76．9％），选择肾动脉栓塞13例．手术23例（15．6％），其中肾切除8例，肾修补15例；选择肾动脉栓塞11例（不包括保守治疗或手术治疗后出现继发性出血的患者4例）。死亡3例。结论 中、重度闭合性肾脏损伤患者伤后应尽可能选择CT检查，明确肾脏损伤程度及是否合并其它脏器损伤。闭合性肾脏损伤治疗以非手术为主，保守治疗期间严密观察病情进展，及时行选择性肾动脉栓塞或手术治疗。选择性肾动脉栓塞治疗肾脏损伤效果可靠，避免了手术和肾切除，值得推荐。

Objective To evaluate the management and diagnosis of 147 cases with blunt renal trauma. Methods 147 cases of blunt renal trauma were retrospectively studied. Results Hematuria was observed in 136 patients of 147 （92.5%）, 48 cases （32.7%） were complicated by shock, and 94 cases （63.9%） by other organ injuries. Renal traumal severity was identified with computerized tomography scan in all patients. 113 cases （76.9%） were managed nonoperatively, 13 cases were treated with selected renal arteriographic embolism, and 23 patients （15.6%） underwent operatively, including nephrectomy （8cases） and neoplasty （15 cases）, and 11 patients were treated with selected renal arteriographic embolism （not including 4 cases with secondary hematuria, which were performed initially nonoperative or operative treatment）. 3 patients died of injury. Conclusions Computerized tomography scan should be performed in severe renal injuries patients to identify renal injuries severity and the presence of associated nonrenal injuries or not. Many blunt renal trauma patients need nonoperatively management by keeping on observe the pathogenetic condition, delayed operative or selected renal arteriographic embolism management should be performed in time. Selected renal arteriographic embolism management should be recommended for which avoids surgery and nephrectomy, and has confirmed effect.