骨盆骨折腹膜后血肿致急性肾功能衰竭的诊治

The diagnosis and treatment of acute renal failure caused by retroperitoneal hematoma in patients with pelvic fracture

目的分析骨盆骨折腹膜后血肿压迫双侧输尿管导致急性肾功能衰竭这种少见并发症的治疗过程,探讨其诊治方法。方法2例肾功能衰竭患者在抗休克成功后行CT检查发现腹膜后血肿,血管数字减影未见髂内动脉及其大分支有活动性出血点。数小时后患者出现无尿,此时测定膀胱内压为3.73kPa,血压稳定(波动在14.0～15.33/8.33～10.0kPa),连续床旁B超检查显示不断增大的腹膜后血肿和双侧肾积水。急手术行骨盆外固定架固定骨盆和双侧输尿管支架支撑双侧输尿管,术后肾功恢复良好并行二期手术进一步固定骨盆。结果2例术后5～8周复查肾功能未见明显异常,骨盆骨折得到良好固定。结论骨盆骨折腹膜后血肿致急性肾后性肾功能衰竭容易和失血性休克导致的肾功能衰竭混淆,其诊断需要结合B超、CT和临床表现,治疗上应使用输尿管支架支撑双侧输尿管、骨盆外固定支架固定骨盆等联合措施。

To explore the diagnosis and treatment of acute renal failure caused by retroperitoneal hematoma in patients with pelvic fracture by analyzing the treatment process of two patients suffered from such complication.Methods After successful anti-shock treatment,all the two patients were found retroperitoneal hematoma by CT examination and found no artery bleeding of the internal iliac artery and its branches by digital subtract angiography.Then oliguria occurred,at which time the intra-bladder pressure was 3.73 kPa along with a stable blood pressure（about 14～15.3/8.3～10 kPa）.Bedside ultrasound examination showed progressively enlarged retroperitoneal hematoma and bilateral hydronephrosis.A double ＂J＂ ureteral catheter was placed in bilateral ureters to support the ureters and external fixation of the pelvis was performed.Eventually the two patients recovered with good renal function and further operation was performed to fix the pelvis.Results Renal function examination showed no abnormity 5 to 8 weeks after injury in all the two patients,and good fixation of the pelvic fracture was achieved.Conclusions Acute renal failure caused by retroperitoneal hematoma can be easily confused with that caused by hemorrhagic shock,and the diagnosis depends on the combination of clinical symptoms,ultrasound examination and CT.Combined measures including external fixation of the pelvic ring and ureteral catheter support is effective measurement under such circumstance.