279例肾损伤的诊治体会

    彭万勇1

    [摘要 ] 目的:提高肾损伤的诊治效果。方法:回顾性分析 279例肾损伤患者的临床诊治资料。结果:血尿

    260例 (占93 . 2% ) ; B超检查 168例 ,其中 122例 (72 . 6% )有异常表现; CT检查 76例 ,阳性表现 63例 (83 . 0% ) ;

    静脉肾盂造影检查 80例 ,其中肾穿透伤 12例 (占15 . 0% ) ,肾钝性伤 3例 (占3 . 8% )。本组患者手术治疗 57例

    (20 . 4% ) ,非手术治疗 222例 (79 . 6% )。死亡 10例 (3 . 6% ) ,治愈 269例 (96 . 4% )。152例 (54 . 5% )随访 1～3

    年 ,尿常规及肾功能检查正常。结论:尿液检查和 B超检查快速、 安全、 无损伤。对于有血尿的肾穿透伤患者 ,或

    虽无血尿但高度怀疑肾损伤的患者 ,如生命体征平稳 ,接受静脉肾盂造影检查是必要的。CT检查准确率高 ,可同

    时了解其他脏器受损程度。如果损伤严重 ,尤其是并发腹内脏器受损时 ,宜适时探查肾脏 ,做出相应的外科处理。

    [关键词 ] 肾损伤;静脉肾盂造影;诊断;治疗

    [中图分类号 ] R691 . 6 [文献标识码 ] A [文章编号 ] 10012 1420 (2005) 032 01502 03

    An exper i ence with 279 ca ses of rena l trauma

    PENG W anyoug

    1

    (

    1

    Depart ment of Trauma Surgery, Uni on Hos p ital, Huazhong University of Science and Technol ogy,Wuhan, 430022, China)

    Abstract Objecti ve: To p resent an experience with 279 cases of renal trauma . Methods: 279 cases of renal trauma

    were retr ospectively analysed . Results:Hematuria occurred in 260 cases (93 . 2% ) ; aberrant findings were observed on

    ultrasonography in 122 out of 168 (72 . 6% ) and on CT scan in 63 out of 70 (90% ) ; I ntravenous pyel ogram ( I VP) was

    performed in 80 patients : abnormal i mageswas obtained in 12 out of 16 patientswith penetratingwounds and in 3 out of

    64 caseswith blunt injuries ; 124 patients had injuries of other organs ; open operati on was undertaken in 57 and 222 were

    treated nonoperatively . 10 (2 . 2% ) died of shock and coexistant injuries of other organs, the other 269 have been cared,152 of which have been foll owed up for 1～3 years with normal urine r outine and renal functi on . Conclusi on s:Urine in2

    specti on and B2 ultrasonography were si mp le、instant、reliable and harmless t o the patient ; The intravenous pyel ogram is

    essential t o the patientswith hematuria and t o the higly suspected cases though without hematuria . The diagnostic rate of

    CT scanning is high, which is als o hel pful in detecting any coexistant injuries . Surgicalmanagement is indicated in cases

    of severe injuries, particularly, if there are other coexisting injuries of abdomen . When hematuria is gettingmore severe

    and the shock of bleeding would be inevitable, the patients should receive operati on in ti me .

    Key words Kidney injuries ; Intravenous pyel ogram;Diagnosis ; Therapy

    我院从 1996年 10月 ～2003年 6月共收治肾

    损伤患者 279例 ,现对其致伤原因、 病情、 诊断与治

    疗措施等方面总结分析如下。

    1 资料与方法

    1 . 1 临床资料

    本组 279例 ,男 157例 ,女 122例 ,年龄 5～67

    岁 ,平均 29 . 7岁。损伤部位为左肾 134例 ,右肾

    105例,双肾 40例。损伤程度按 Sargent分类:肾挫

    伤 120例 ,肾裂伤 111例 ,肾碎裂伤 39例 ,肾蒂血

    管伤 9例。致伤原因为高处坠落伤 86例 ,钝性打

    击伤 69例 ,交通事故伤 38例 ,锐器刺伤 24例 ,其

    他损伤 62例。并发伤为脾破裂 18例 ,肠管及系膜

    挫裂伤 20例 ,胰腺挫裂伤 8例 ,肝破裂 5例 ,肋骨

    骨折、 血气胸及创伤性湿肺 28例 ,骨盆骨折 45

    1

    华中科技大学协和医院创伤外科 (武汉 , 430022)

    例,颅脑外伤 25例 ,其他骨折 20例 ......