多发伤中闭合性肾损伤146例的诊治体会

The diagnosis and treatment of renal injury in multiple organ trauma(report of 146 cases).

目的 为了解和提高闭合性肾损伤在多发伤中的诊治效果。方法 对 146例肾外伤的诊治进行了总结。将美国创伤外科联合会的五级标准法与 Sargent提出的 类伤分类法相比较 ,认为后者临床较为实用。结果 肉眼血尿12 9例 (88.4% )。血尿量的多少并不完全反应肾损伤的严重程度。B超检查阳性率 95 .5 % ,对 、 类肾损伤检出率10 0 %。建议在多发伤中常规首选 B超定性检查。CT检查 类肾损伤时尿外渗及血肿诊断正确率 10 0 %。非手术治疗 97例 (6 6 .4% ) ,手术治疗 5 2例 (33.6 % )。结论 建议 、 类肾损伤可保守治疗 , 、 类肾损伤需早期手术治疗。

Objective To improve the diagnosis and treatment of closed renal injury in multiple trauma.Methods One hundred forty six renal injury cases were grouped into categories following not only the Five Standards recommended by American Trauma Surgery Assocition but also the Four Types by Sargent.A comparison was made between the two sets of grouping.Results There were 129 cases with visible hematuria.The result of quantitation of hematuria was not completely associated with the severity of injury.By ultrasonic examination,the total diagnostie rate reached 95.5%,and all of the type Ⅲ and Ⅳ injuries could be detected.There were 97(66.4%) non surgical cases and 52 (33.6%) surgical cases.Conclusion The Four Types by Sargent is more applicable to the clinical diagnosis of renal injury.Ultrasonography should be the first choice in the routine examinations for the diagnosis of multiple trauma.In the case of urine exudation and/or hematoma after injury,correct diagnosis could be made with the use of CT.Conserrative approach is recommended for the treatment of type Ⅰ or Ⅱ renal injury cases.If the renal injury belongs to type Ⅲ or Ⅳ,early surgical operation must be performed.