儿童肾外伤的急症处理

Emergent management of blunt renal injuries in children

目的 :提高儿童肾外伤的早期诊断和治疗 ,保存肾功能。方法 :对 5 6例儿童肾外伤进行回顾性分析 (男44例 ,女 12例 ) ,其中 4例先天性肾盂、输尿管交界处狭窄引起肾积水破裂 ;2 9例合并其他脏器损伤 (2 9/ 5 6 ) ,包括骨盆骨折 6例 ,尿道损伤 4例 ,大腿皮肤撕脱伤 2例 ,膀胱损伤 2例 ,脾破裂 6例 ,胰腺损伤 2例 ,胫骨骨折 2例 ,肝损伤 5例 ;休克 12例 (12 / 5 6 ) ;对侧肾积水 3例 (3/ 5 6 )。全组患儿有肉眼血尿和患肾区触痛。结果 :48例患儿保守治疗 ,2例行Anderson Hynes肾盂成形术 ,2例行肾切除术 ,4例行肾缝合术。随访 0 .5～ 6年 ,肾功能改善。 结论 :对肾损伤患儿 ,一般不需手术治疗 ,只有发生严重肾损伤 ,需行肾探查术或切除术。静脉肾盂造影和CT检查对儿童肾外伤的早期诊断和治疗非常必要。

Objective: To achieve better standard of early diagnosis and management of Blunt Renal Trauma in children. Methods: Retrospective review of 56 children (44 boys and 12 girls), 4 congenital anomalies were incidentally discovered primary pelviureteric junction (PUJ) obstruction with hydronephrosis rupture. 29 patients (29/56) sustained extrarenal injuries. Pelvic fracture in 6 patients. Urethra injury in 4 patients. Leg skin avulsion in 2 patients. Ruptured bladder in 2. Splenic injury in 6. Pancreatic injury in 2. Tibia fracture in 2. Liver injury in 5. Shock in 12(12/56). Opposite hydronephrosis in 3(3/56). All of these patients were with macroscopic hematuria and loin tenderness on the side of the renal pathology.Results: 48 cases received nonoperative management. 2 cases were treated with Anderson Hynes pyeloplasty, 2 cases Nephrectomy. and 4 patients renal suture. Follow up lasted 0.5 to 6 years. Kidney function recovered. Conclusion: Most patients were treated nonoperatively. Only those with severely injured kidney required laparotomy or nephrectomy. Intravenous phlebography (IVP) and Computer Tomography Scanning (CT) are necessary for early diagnosis and management of Blunt Renal injuries in children. (J Beijing Med Univ, 2000,32:175 177)