非手术治疗严重闭合性肾损伤38例分析

NONOPERATIVE TREATMENT OF SEVERE CLOSED RENAL INJURIES(WITH 38 CASES)

目的 评价非手术疗法在严重闭合性肾损伤中的疗效。方法 对 1990年 3月至 1999年5月间保守治疗的 38例严重闭合性肾损伤病例进行回顾性分析。结果 38例病人中 ,3例因持续低血压 ,2例因持续性血尿不减轻而改行肾部分切除或半肾切除术 ;33例保守治疗成功 ,2 6例随访6～ 2 4个月 ,血清BUN及肌酐均正常 ,2例轻度肾积水 ,1例肾萎缩 ,1例高血压 ,1例发生尿性囊肿 ,经皮穿刺引流后消失。 19例肾脏ECT显示患侧肾脏的功能占总肾功的 18%～ 4 3.5% (平均 35.5% )。结论 保守疗法是治疗重度闭合性肾损伤的一种较为安全可靠的方法 ,能最大限度地保留有功能肾组织 。

Objective To evaluate the role of nonoperative treatment in treating severe closed renal injuries.Methods 38 cases of severe closed renal injuries treated from March,1990 to May 1999 were reviewed and analyzed.Results Of the 38 patients who were managed with nonoperative treatment in the initiation, partial nephrectomy or half-nephrectomy were performed on 5 patients due to continuous hypotension(3 patients) or persistent hematuria (2 patients). While 33 cases were treated successfully with nonoperative treatment,26 of them were followed up for 6 to 24 months. All of them had normal serum BUN and creatinine. 2 cases had slight hydronephrosis, one had renal atrophy and one had hypertension.Urinoma occurred in 1 case and was closed with percutaneous drainage. In 19 patients who underwent renal ECT scanning, the function of injuried kidneys was at 18% to 43.5% (mean 35.5% of the total).Conclusion The nonoperative treatment is a safe and effective approach in managing severe closed renal injuries. It can retain the vital renal tissue in the greatest limitation without significantly increasing the incidence of complications.