小儿闭合性肾损伤的诊治及疗效分析(附37例报告)

Analysis of Diagnosis and Curative effect of Renal Injury from Blunt Trauma in Children

目的:探讨提高小儿闭合性肾损伤的诊治效果.方法:回顾分析37例小儿闭合性肾损伤的诊治资料,结果:B超检查16例,15例有异常表现.CT检查22例,95.5%(21例)发现肾损伤.静脉肾孟造影10例,发现异常8例.保守治疗31例,其中肾挫伤26例,肾裂伤5例,手术治疗6例(保守治疗失败转手术3例).35例治愈出院,1 例治疗好转后回当地治疗,死亡1例.21例(56.8%)随访1年～5年,血压、尿常规和肾功能均正常.结论:小儿闭合性肾损伤的最主要原因是直接暴力.血尿是闭合性肾损伤最常见的症状,也是在保守治疗中观察病情变化的一项重要指标.B超可初步了解肾损伤和肾内外血肿,对合并的尿外渗及肾周积尿可明确诊断.CT在诊断肾挫伤、肾裂伤和肾内血肿中准确率很高,能对损伤进行分类,且可同时发现其他脏器的损伤.静脉尿路造影可了解分肾功能、肾孟肾盏形态、有无尿外渗.闭合性肾挫伤和轻度肾裂伤可保守治疗,严重的尿外渗、肾碎裂伤和肾蒂伤需及时手术探查.小儿生性顽皮,治疗中一定要注意保持卧床休息.

Objective: To investigate the efficacy of diagnosis and treatment of blunt renal trauma in children. Methods: 37 cases of blunt renal trauma were retrospectively analyzed. Results: Aberrant findings were observed on 15 of 16 cases with B-ultrasonography, 21 of 22 cases with CT scan and 8 of 10 cases with IVU. 31 sick children were treated conservatively. Open operation was undertaken in 6 cases. One case died of shock and co-existent injury of other organs. 21 cases have been followed up for 1~5 years. All of them were detected in normal with blood pressure, urine routine and renal function. Conclusion: The renal trauma was mostly caused by direct force in children. Hematuria was the most familiar symptom. Ultrasonography was used to identify the renal trauma and intrarenal or perirenal hematoma. CT scan could be the most reliable in evaluating the extent of the renal trauma and to detect any associated injury of other organs. IVU could show another renal function, the form of pelvis and calyx, contrast extravasation or a retroperitoneal mass. The minor renal injuries were amenable to conservative, non-operatively management and that major renal porechymal and vascular lesions required immediate surgical repair. It should be necessary for the children with renal trauma to keep bed rest.