摘要
目的总结我科5年来收治的肾损伤合并严重尿外渗的处理及转归。方法对21例肾外伤伴严重尿外渗患者，通过静脉尿路造影、CT、彩超等检查确诊后，18例入院后安放伤侧输尿管支架管引流尿液并进行随访行保守治疗，3例由于血流动力学不稳定行急诊手术探查。结果21例肾外伤伴尿外渗患者17例（Ⅳ级损伤）保守治疗成功，随访5～46个月，肾功能均正常，无血尿、结石、肾性高血压等并发症的发生；3例急诊开放行肾切除术，1例Ⅱ期行部分肾切除术，所有需外科处理的患者均为高级别肾损伤Ⅳ或Ⅴ级。结论肾损伤伴严重尿外渗患者（Ⅳ级损伤）早期安放输尿管内支架经保守治疗多数可获良好疗效。
Objective To discuss the five-year experience of our department in the diagnosis and treatment of renal trauma with severe urinary extravasation. Methods During the last 5 years,21 cases suffering from renal injury with severe urinary extravasation in our department were checked by intravenous urogram （IVU） and computer tomography （CT） with IV contrast. After diagnosis of the renal trauma with urinary extravasation by CT or color doppler ultrasound,endoscopic ureteral stent placement was attempted in 18 cases. Three patients with hemodynamic instability at the time of hospitalization accepted emergency operation. Results Seventeen cases of renal trauma with severe urinary extravasation （Grade Ⅳ ） were cured with conservative treatments by endoscopic ureteral stents double ＂J＂ placement. The follow-up time was 546 months with normal kidney＇s function,without complication as hematuria, stone,kidney hypertension;while 3 cases with hemodynamic instability accepted nephrectomy with renal injury of Grade Ⅴ;1 case was treated with a delayed retroperitoneal partial nephrectomy with renal injury of Grade Ⅳ. Conclusion Most cases of renal trauma with severe urinary extravasation（ Grade Ⅳ ） could be cured nonoperatively with endoscopic ureteral stents placement in early stage.
出处
《创伤外科杂志》
2009年第2期134-136,共3页
Journal of Traumatic Surgery
关键词
肾损伤
尿外渗
输尿管
renal trauma
urinary extravasation
ureter
