多发脏器损伤合并创伤性肾上腺出血的诊治分析(附29例病例)

Diagnosis and treatment of traumatic adrenal hemorrhage combined with multiple organ injury(report of 29 cases)

目的通过探讨成人创伤性肾上腺出血的诊断与治疗,提高对成人创伤性肾上腺出血的认知。方法回顾性分析2010年5月至2019年10月在上海市交通大学医学院附属松江医院泌尿外科诊治的29例成人创伤性肾上腺出血患者的资料,包括临床表现、影像学特征、治疗方法和愈合情况,其中男25例,女4例,患者均在ICU、胸外科、骨科等科室治疗。结果29例患者均为单侧肾上腺出血。所有患者皆行CT检查诊断为创伤性肾上腺血肿,皆予以保守治疗,患者恢复好,门诊复查随访,未有因肾上腺损伤出血而引起肾上腺功能不全的患者。结论成人创伤性肾上腺血肿相较其他脏器创伤后血肿发生少,诊断相对困难,CT是其首选的影像学检查。创伤性肾上腺血肿如诊断与治疗及时,基本上保守治疗就可以痊愈,包括大于50 mm血肿也无需手术治疗。对于同时合并多脏器损伤出血的患者,需予以同时治疗。

Objective To deepen the understanding of traumatic adrenal hemorrhage and to discuss its diagnosis and treatment.Methods A retrospective analysis was conducted in our hospital.From May 2010 to Oct 2019,29 cases of traumatic adrenal hemorrhage in adults were collected,including 25 males and 4 females.Their clinical manifestation,imaging features,treating methods and recovery were then assessed.All the cases were diagnosed by urologist,and most of them received multidisciplinary treatment by department of thoracic surgery,orthopedics or ICU.Results All 29 cases were diagnosed as unilateral adrenal hemorrhage by CT scan.All of them were treated conservatively and made a good recovery.None of them suffered from adrenal insufficiency during the follow-up.Conclusions Adult traumatic adrenal hemorrhage is more difficult to diagnose because of its tendency to lack of hematoma compared to other visceral injuries.CT scan is the preferred medical examination.Most patients,including those with hematoma larger than 50 mm,can make good recoveries by conservative treatment if diagnosed in time.Treatment to hemorrhage in other organs is usually needed given that traumatic adrenal hemorrhage is usually part of a multiple trauma.