小儿闭合性肾损伤放射影像学检查必要性探讨

Necessity of radiological examination in pediatric close renal injury

目的 探讨小儿闭合性肾损伤放射影像学检查的必要性 ,以降低医疗费用。方法 回顾性分析我科自 2 0 0 0年 1月至 2 0 0 3年 6月的 6 9例 6～ 14岁闭合性肾损伤患儿的临床资料。结果 6 9例闭合性肾损伤患儿 ,肉眼血尿 11例 ,镜下血尿 5 8例。 11例肉眼血尿患儿行肾脏CT或IVU检查 ,检出 9例Ⅱ～Ⅳ类肾损伤 ,2例肾挫伤 ,且 9例Ⅱ～Ⅳ类肾损伤患儿中 7例伴有不同程度的其他脏器损伤。镜下血尿 5 8例患儿中 ,2 1例未行影像学检查 ,37例行螺旋CT或IVU检查 ,32例表现为正常或肾挫伤 ;5例表现明显的肾损伤 (Ⅱ～Ⅳ类 ) ,且均伴有其他脏器的损伤。结论 小儿闭合性肾损伤 ,镜下血尿的程度与肾损伤严重程度不一致 ,但肾损伤严重者 (Ⅱ～Ⅳ类 ) ,均伴有其他脏器损伤 ;闭合性肾损伤性镜下血尿 ,如果不伴有其他脏器损伤 ,不必行放射影像学检查 ,但肉眼血尿和镜下血尿疑有其他脏器损伤 。

Objective To study the necessity of radiologic evaluation in pediatric closed renal injury so as to find ways to reduce medical costs. Methods We reviewed the medical records of 69 children (age: 6～14 years) who were hospitalized with blunt renal trauma between January 2000 and June 2003. Results Of the 69 pediatric patients with closed renal injury, 11 cases had gross hematuria and 58 cases had microscopic hematuria. All patients with gross hematuria were evaluated with renal radiologic examination which demonstrated 9 cases of Ⅱ～Ⅳ grade renal injuries, and 2 cases of renal contusions. In the 9 cases of Ⅱ～Ⅳ grade renal injuries, there were 7 cases with accompanied other injuries. Of the 58 cases with microscopic hematuria, 21 cases did not have radiologic examination. In the remaining 37 cases undergoing radiologic evaluation, 32 cases were normal or just showed renal contusions. 5 cases had significant renal injuries (Ⅱ～Ⅳ grade) and with accompanied other injuries. Conclusions In pediatric closed renal trauma, the degree of hematuria does not correlate with the severity of the injury. Patients with microscopic hematuria, if they have significant renal injuries (Ⅱ～Ⅳ grade), they have other accompanied trauma. If they do not have other trauma, radiologic evaluation is not necessary. In patients with gross or microscopic hematuria and associated injuries, radiologic evaluation should be performed.