腰腹部外伤致肾动脉栓塞医疗损害鉴定1例

A case of medical damage about renal artery embolism caused by lumbar and abdominal trauma

肾动脉闭塞可由血栓形成或栓塞导致。肾动脉血栓形成可自发发生,或作为钝器伤、刺伤后的并发症,或发生于血管外伤、血管造影操作后。在受到严重的腰腹部外伤时,因腹壁和脊柱挤压及牵扯,肾脏发生剧烈移动,肾蒂受到猛烈牵拉,会导致肾蒂及肾动脉损伤。肾动脉内膜损伤后容易形成血栓,并引起肾动脉闭塞。在发生腹部损伤后,可通过影像学检查如彩超、CT等明确是否存在肾脏损伤,超声检查可以明确肾脏血流是否减少。外伤性的肾动脉栓塞并非外伤后立即形成,且该类损伤症状隐匿,因此在诊疗过程中容易漏诊。通过案例对入院患者的诊疗过程中存在的过错及不足进行详尽分析,为解决同类问题提供参考。

Renal artery occlusion can be caused by thrombosis or embolism.Renal artery thrombosis can occur spontaneously or as a complication after blunt injury or stabbing injury,or after vascular trauma or angiography.In severe lumbar and abdominal trauma,the compression of abdominal wall and spine can cause renal pedicle and renal artery injury.After the injury of renal artery intima,it is easy to form thrombus and cause renal artery occlusion.After the occurrence of abdominal injury,the presence of renal injury can be determined by imaging examination,such as color Doppler ultrasound and CT,and ultrasound examination can determine whether renal blood flow is reduced.Traumatic renal artery embolism is not formed immediately after trauma,and the symptoms of this kind of injury are hidden,so it is easy to miss diagnosis in the process of diagnosis and treatment.This case makes a detailed analysis of the faults and deficiencies existing in the diagnosis and treatment of patients after admission,and provides a reference basis for solving similar problems.