单纯闭合性肾损伤伴血性腹水的诊断与治疗

The management of simple close renal trauma complicated with hemoperitoneum

目的探讨单纯闭合性肾损伤伴有血性腹水时的最佳治疗方法。方法回顾性分析16例单纯闭合性肾损伤伴血性腹水的诊治资料。结果16例患者中Ⅱ级肾损伤3例,Ⅲ级肾损伤8例,Ⅳ级肾损伤1例,Ⅴ级肾损伤2例。入院诊断10例考虑合并有腹腔内脏器损伤,1例诊断为肝破裂。非手术治疗5例,均获成功。其中保守治疗2例,超选择性肾动脉栓塞术3例。开放手术11例。其中肾修补术6例,肾切除术5例,失肾率为45.5%。结论肾损伤引起血性腹水时,会给临床判断有无腹腔内脏器合并伤带来困难。非开放手术治疗为首选治疗方法,手术探查应在积极保守治疗后生命体征仍不稳定的情况下进行,手术探查指征的放宽会造成较高肾切除率。

Objective To determine the optimal management,nonoperative or surgical,for patients with simple close renal trauma complicated with hemoperitoneum.Meth ods 16patients diagnosed with simple close renal trauma complicated with hemoperitoneum were ret-rospectively analysed.Re sults Of 16patients,3patients had gradeⅡrenal injuries,8patients had gradeⅢ,1patient had gradeⅣ,2patients had gradeⅤ,respectively.10patients were suspected of associated intraabdominal organ injuries and1patients was diagnosed as liver disruption on admission.5patients were successfully managed nonoperatively including2cases of conservative management and3cas-es of supra selective renal artery embolization.Among11patients who had surgical management ,5patients had repair of the renal lacera-tion and6patients had nephrectomy,respectively.The renal loss rate was45.5%.Conclusion Close renal trauma complicated with hemoperitoneum is difficult in differential diagnosis with intra-abdominal organ associated injuries.Routine surgical exploration would in-crease the nephrectomy rate and therefore should be made only after aggressive nonoperative management failed.[