肾脏穿刺伤救治体会

Optimal management of penetrating renal injuries

目的探索肾脏穿刺伤的救治方法及疗效。方法回顾我院2001年3月-2008年5月收治肾脏穿刺伤患者13例,就其损伤原因、损伤程度（根据美国创伤外科协会分级标准）、处理方法及结果进行分析。结果本组13例肾损伤均为利器穿刺伤,其中Ⅰ-Ⅱ级损伤2例均行保守治疗成功;Ⅲ级损伤4例,其中1例保守治疗成功,3例接受肾血管造影并行超选择性动脉栓塞（TAE）止血成功;Ⅳ级损伤6例,其中1例伴血流动力学稳定患者行TAE成功,3例接受肾脏探查修补术,2例行肾切除术;Ⅴ级损伤1例,探查发现伴脾脏损伤,行左肾切除＋脾切除术。13例获随访,平均31.5个月,保守治疗及保存肾脏患者肾功能良好,无并发症发生。结论低中级别（Ⅰ-Ⅱ）肾脏穿刺伤保守治疗成功可能性大,部分高级别（Ⅲ-Ⅳ级）肾穿刺伤患者选择保守或肾功脉栓塞等微创治疗,创伤小,且避免手术探查导致的高伤肾切除率。

Objective This study reviews our experience in the management of penetrating renal injuries. Methods The medical records of patients with penetrating renal injuries were retrospectively reviewed during a period of 8 years at our hospital. The data included injury mechanisms, injury grade （ according to American Association for the Surgery of Trauma,AAST） ,management and outcome. Results There were 13 patients,whose injury mechanisms were stab wounds. Two patients of grade Ⅰ - Ⅱ renal injuries were treated conservatively. One patient of grade Ⅲ injuries was treated conservatively and 3 of grade Ⅲ accepted angiography and super-selective transarterial embolisation（TAE）. In 6 patients with grade-Ⅳ injuries, 1 patient with stable hemodynamics accepted TAE,3 patients renal exploration and renorrhaphy,2 patients nephrectomy. One patient subjected to grade Ⅴ injuries with splenic injury required left nephrectomy and splenectomy. The function of reserved kidney was stable. There were no complications occurred at a mean follow up of 31.5 months. Conclusion Nonoperative treatment is a reasonable option for the majority of minor penetrating renal injuries as well as in some selected high-grade （ Ⅲ-Ⅳ） ones. Transarterial embolisation（TAE） provides a minimally invasive treatment option for renovascular injuries and potentially obviates the need for surgical exploration,leading to higher incidence of nephrectomy.