165例闭合性肾损伤临床分析

Clinical Analysis of Closed Renal Injury,Report of 165 Cases

本文对我院1967～1988年收治的165例闭合性肾损伤进行了分析。对于肾损伤的类型损伤机制,合并伤,以及早期诊断和治疗进行了讨论。作者认为大多数肾损伤是可以保守治疗的,但对于 X 线有肾裂伤表现,局部肌紧张并有肾区包块,或出现进行性血尿,血红蛋白下降,腰部血肿迅速增大,宜早期手术治疗。作者强调指出,对合并多脏器损伤,病情危及病例,应争取时间即行剖腹探查术。切开后腹膜,先控制肾蒂血管出血然后处理肾脏,只要伤情允许,疑有肾损伤病人均应早期行进大剂量排泄性尿路造影检查,及时处理并发症有利于病人健复,本文死亡率很低,死因多为合并多脏器损伤所致。

One hundred and sixty-five cases of traumatic closed renal injury treated from 1967to 1988 in Tianjin Hospital were analysed.The types of injury,mechanisms,compli-cated injuries,early dagnosis and treatments were discussed.It was thought that mostrenal trauma might be recovered after conservative treatment.Early operative treat-ment was necessary for the appearance of rupture of kidney on X-ray film.Local muscu-lar tension,progresive bloody urine,decreasing Hb and rapidly increasing hematoma.Itwas pointed out for emergency cases associated with multiple organ injury,exploratorylaparotomy must be performed immediately.As soon as the posterior peritoneum isincised,angiorrhagia of renal stalk must be controlled at once,then the condition ofthe kidney was managed.If possible,the patients suspected with renal trauma shouldbe examined with drip infusion IVP in the early period.Immediate managementof complication was benifit for the patients.The death rate in this series was low.Deaths often resulted from renal trauma associated with multiple organ injury.