摘要
目的探讨Ⅲ-Ⅴ级闭合性肾脏损伤的诊断和治疗要点。方法回顾性分析收治的49例Ⅲ-Ⅴ级闭合性肾脏损伤(美国创伤外科协会american association for the surgery of trauma,AAST)的临床资料。Ⅲ型28例,Ⅳ型16例,V型5例。结果保守治疗31例,手术治疗12例(肾切除8例,肾修补4例),选择肾动脉栓塞6例。治愈47例(95.9%)。结论中、重度闭合性肾脏损伤患者伤后应尽可能选择CT检查,明确损伤程度及是否合并其他脏器损伤。治疗方法取决于损伤的程度。保守治疗是治疗肾脏损伤的重要方法,选择性肾动脉栓塞治疗肾脏损伤效果可靠,避免了手术和肾切除。对部分患者必须进行手术干预,因此及时、准确、合理把握手术指征,显得非常重要。保守治疗期间应严密观察病情进展,病情无明显改善者,应及时行选择性肾动脉栓塞或手术治疗。
Objective To evaluate the management and diagnosis of 49 cases of AAST Ⅲ - Ⅴ Grade renal trauma. Methods The clinical data of 49 cases of Ⅲ - Ⅴ Grade renal trauma were studied retrospectively , including 28 cases of AAST Ⅲ Grade renal trauma, 16 cases of AAST Ⅳ Grade renal trauma,and 7 cases of AAST V Grade renal trauma. Results 31 cases were managed nonoperatively, 12 patients underwent operatively, including nephrectomy （ 8 cases） and neoplasty （4 cases） , and 6 cases were treated with selected renal arteriographic embolism. 2 patients diedofinjury. Conclusion Computerized tomography scan should be per- formed in SeVere renal injuries patients to identify renal injuries severity and the presence of associated nonrenal injuries or not. The renal injuries severity is a key factor for treatment,and nonoperatively management is one of the most important ways. Selected renal arte- riographic embolism management should be recommended for which avoids surgery and nephreetomy, but also some patients needed operative intervention. Renal trauma patients who were treated nonoperatively need by keeping on observe the pathogenetic condition, delayed operative or selected renal arteriographic embolism management should be performed in time.
出处
《河南外科学杂志》
2011年第4期8-10,共3页
Henan Journal of Surgery
关键词
中重度肾脏损伤
选择性肾动脉栓塞
肾切除
Severe renal trauma
Selected renal arteriographic embolism
Nephrectomy
