44例闭合性肾损伤诊疗体会.doc

44例闭合性肾损伤诊疗体会 　 作者：张存明，胡明明，沈周俊 【摘要】 目的 总结我院闭合性肾损伤诊疗的临床资料，以改善闭合性肾损伤的诊治效果。方法 回顾性分析44例闭合性肾损伤的诊治资料。结果 本组44例，右肾损伤20例，左肾损伤21例，双肾损伤3例。44例均行尿液常规分析，其中38例有血尿表现，阳性率86.4%;B超检查34例，其中23例(67.6%)有异常表现;CT检查40例，阳性表现36(90%)。多发伤16例。手术5例(11.4%)，非手术39例(88.6%)，无死亡病例。其中19例随访12～60个月，尿常规、肾功能、血压正常表现。结论 尿液检查、超声检查、CT检查安全无创，并且CT检查准确率高、能兼顾其他脏器损伤程度的判定。CT检查和循环改变表现严重时也有较大的保守治疗的可能性。 【关键词】 肾损伤;诊断;治疗 　　Abstract： Objective To propose an update viewpoint for treating closed renal trauma,so as to improve the effectiveness of diagnosis and treatment.Methods Data on 44 cases of closed renal trauma were retrospectively analyzed.Results Right renal trauma was found in 20 cases,left renal trauma in 21 cases，double renal trauma in 3 cases.Hematuria occurred in 38 out of 43 cases(86.4%).Abnormal imaging manifestation was observed in 23 out of 34 cases(67.6%) on ultrasonography and on CT scan in 36 out of 40 cases(90%).There were 16 cases of injury of other organs.Operation was undertaken in 5 cases(11.4%),and the others were treated nonoperatively.There was no dead case.All of 44 cases were cured,and 19 cases were followed up for 1260 months with normal urine,blood pressure and renal function.Conclusion Urine routine,Bultrasonography and CT scan are safe and noninvasive examinations.CT is precised,which is beneficial to determine the degree of injury.Sometimes even if the degree of injury is high in the CT scanning and circulation change,there is chance to perform nonoperative treatment. 　　Key words：renal injury;diagnosis;treatment 　　肾损伤在临床上较为常见[1]，占腹部钝性损伤以及刀刺伤的8%～10%。我院自1996年1月～2008年5月共收治闭合性肾损伤患者44例，现对其致伤原因、病情、诊断、治疗等方面予以总结分析。具体报告如下。 临床资料 　　1 一般资料 　　本组44例，男性35例，女性9例;年龄2～61岁，平均41.3岁。住院天数4～47天，平均住院17.2天。致伤原因：道路交通事故13例，高处坠落8例，钝物撞击伤13例，斗殴伤7例，挤压伤1例，其他无明显诱因2例。损伤部位：右肾20例，左肾21例，双肾损伤3例。损伤程度按Sargent分类：肾挫伤28例，肾裂伤12例，肾粉碎伤4例，无肾蒂损伤病例。按美国创伤外科协会标准进行肾损伤分级：Ⅰ级15例，Ⅱ级12例，Ⅲ级8例，Ⅳ级7例，Ⅴ2例。44例中合并脾脏损伤6例(脾挫伤3例，脾破裂3例)，骨盆骨折5例，胰腺挫裂伤1例，颅脑外伤2例，肋骨骨折1例，椎骨骨折3例，后尿道损伤1例，四肢骨骨折及脱位3例(股骨干骨折3例，桡骨骨折1例，腕关节脱位1例)，肺部挫伤1例。合并休克5例。 　　2 临床症状、体征及辅助检查 　　本组44例有血