多发伤中肾脏损伤的诊治

Diagnosis and management of renal injury in multiple injury

目的 探讨在多发伤中肾脏损伤的诊治。方法 对 1992～ 2 0 0 0年间收治的 5 6 0例多发伤肾损伤进行回顾性分析。多发伤 (ISS 16～ 4 0 )肾损伤合并脾破裂 15 8例 ,肝破裂 74例 ,骨盆及四肢骨折 92例 ,脊柱骨折 10 2例 ,胸外伤 2 6例 ,膈肌破裂 7例 ,颅脑损伤 10 1例。肾脏损伤 :Ⅰ类肾挫伤 2 33例 ,Ⅱ类肾挫裂伤174例 ,肾包膜下血肿 4 4例 ,Ⅲ类肾实质破裂 10 3例 ,Ⅳ类肾蒂撕裂伤 6例。血尿 5 5 4例。结果 行肾切除34例 (占肾手术的 6 3% ) ,肾修补 2 0例 (37% ) ;保守治疗 5 0 6例 ,除 18例严重损伤死亡外 ,其余救治成功。结论 多发伤的治疗首先是抢救生命 ,对肾损伤仍以保守治疗为主。

Objective To study the diagnosis and management of renal injury in multiple injury.?Methods Retrospective review of 560 cases of renal injury in multiple injury from 1992 to 2000 in our hospital.Renal injury in multiple injury (ISS 16 40) accompanied with injury of spleen in 158, hepatic injury in 74, pelvic fracture and limb fracture in 92, spinal fracture in 102, thoracic injury in 26, diaphragmic injury in 7,head injury in 101. About renal injury,233 cases had type Ⅰ injury, in type Ⅱ 218, in type Ⅲ 103,in type Ⅳ 6,with hematuria in 554.?Results Five hundred and six cases received non operative management. Thirty four cases (63%) were treated by nephrectomy and 20 cases (37%) received renal suture. Treatment has been successful in all except 18 cases who died of serious injuries.?Conclusion The first aid of multiple trauma is life support. Most renal injury patients were treated non operatively. One of the reasons of high nephrectomy rate is laparotomy with no special preoperativel examination.