(外科学课件）14.1-Genitourinary Trauma（翻译）.ppt

Free photoshow template from * Treatment 3．Operative Management （1）Penetrating injuries穿通伤：Penetrating injuries should be surgically explored(手术探查). Free photoshow template from * Treatment （2）Blunt injuries：钝器伤 Cases in which operation is indicated include those associated with persistent retroperitoneal bleeding（持续性腹膜后出血）： ① vital sign could not improved after shock treatment actively. Free photoshow template from * ②Hematuria become more serious or heamoglobin 血红蛋白and haematocrit 血细胞比容decrease persistently. ③Mass in flank area or abdomen augment gradually. ④ Suspection of abdominal organ trauma. Free photoshow template from * Treatment Surgical exploration of the acutely injured kidney is best done via a intraabdominal approach腹腔通道, which allows complete inspection of intraabdominal organs and bowel. The renal vessels are isolated before exploration to provide the immediate capability to occlude封闭 them if massive bleeding should ensue once Gerota’s fascia is opened. Free photoshow template from * Renal Reconstruction Vascular repair Nephrectomy 肾切除术 Free photoshow template from * Treatment 4. Treatment of complications urinoma尿性囊肿 or perinephric abscess肾周脓肿 demands prompt surgical drainage（引流）. Malignant hypertension requires vascular repair or nephrectomy. Hydronephrosis 肾盂积水may require surgical correction or nephrectomy. Free photoshow template from * Bladder Trauma Bladder Trauma occur most often from external force and are often associated with pelvic fractures （骨盆骨折）. Accordingly, when bladder injury is present, other severe injuries are usually associated. Free photoshow template from * Etiology 1. Bladder injuries after blunt trauma钝器伤 are overwhelmingly不可抗拒的 associated with pelvic fracture. Most patients with bladder injuries (83% to 100%) have an associated pelvic fracture. Free photoshow template from * Etiology 2. Penetrating bladder injuries are commonly associated with major abdominal injuries, and