肾脏损伤的诊断与治疗(附72例报告)

DIAGNOSIS AND TREATMENT OF RENAL TRAUMA

目的：总结肾脏损伤诊断及处理经验。方法：回顾总结我院1998至2006年收治肾脏损伤72例。结果：男性59例（81.9%）;女性13例（18.1%）。年龄4.564岁,左侧42例（58.3%）、右侧29例（40.3%）、双侧1例（1.4%）。伴血尿38例（53%）,并休克16例（28%）,有合并伤36例（50%）。本组病理性肾损伤7例（9.7%）,其中肾、输尿管结石4例、肾盂输尿管连接部狭窄、肾透明细胞癌和肾错构瘤各1例。行CT检查23例（32%）,保守治疗54例（75%）;手术治疗18例（25.0%）,其中肾切除9例（12.5%）、肾修补8例（11.1%）、血肿引流1例（1.4%）。平均住院12.6天,死亡2例。出院后随访36个月,手术组无明显并发症,保守治疗54例中随访42例,13月B超提示肾周少量积液2例,6个月后复查正常。结论：血尿是肾脏损伤的重要线索,CT平扫和增强是肾脏损伤的重要检查方法,要重视对病理性肾损伤的处理,进行肾脏手术时,必须重视各种重建修复技术以防止肾脏丧失,严格掌握肾切除指征。

Objective：To analyse the diagnosis and treatment of renal trauma.Methods： Data of 72 cases of renal trauma in our hospital from 1998 to 2006 were analyzed retrospectively.Results： Among 72 cases,38（53%） had hematuria,16（28%） had shock,36（50%） had combined trauma.7 cases were pathological renal in-jury.23（32%） cases were diagnosed by CT scan.54 cases（75%） were treated conservatively,18（25%） were oper-ated.Among the operated cases,9（12.5%） were performed nephrectomy,8（11.1%） got kidney repair,1（1.4%） received hematoma drainage.42 in conservative group were followed up and 2 cases with a few liquid around kidney in 13 month and were recovered 6 month later.Conclusion： Hematuria is an important sign of renal trauma.The diagnosis relies on CT scan.It is important that clinical experts need pay attention to the diagnosis and treatment of pathological renal injury.