89例闭合性肾损伤诊断及治疗.docVIP

89例闭合性肾损伤诊断及治疗 　 作者：陈强文，周练兴，张雄伟，吴汉潮 【摘要】 目的 探讨提高闭合性肾损伤的诊断和治疗水平。方法 对1996年1月～2007年12月收治的89例闭合性肾损伤患者的临床资料进行回顾性分析，综合应用尿常规、B超、CT等检查确诊。肾损伤分级：Ⅰ～Ⅴ级分别为19、23、27、14、6例。合并其他脏器损伤12例，其中颅脑伤1例，肺挫伤1例，肝、脾、肠等腹腔脏器伤7例，肋骨、脊柱、骨盆、四肢骨折3例。根据病情选择保守治疗69例(77.53%)，手术治疗 20例(22.47%)，其中肾切除15 例，保肾手术5例，其他合并伤均进行了相应手术或其他保守治疗。结果 本组89例均痊愈出院，无死亡病例。结论 B超可作为肾损伤尤其是急诊肾损伤患者首选检查,CT检查是闭合性肾损伤快速准确诊断、正确评估肾损伤程度和选择治疗方案的重要依据,合理保肾是闭合性肾损伤的有效治疗方法。 【关键词】 肾损伤;诊断;治疗 　　Abstract： Objective To explore how to improve the level of diagnosis and treatment of closed renal injury.Methods The clinical data of 89 cases of closed renal injury treated between Jan.1996 and Dec.2007 were retrospectively analyzed.Urine routine test,Bultrasound and CT were applied synthetically to confirm the diagnosis.The injury was divided to five degrees from I to V.Each of the degree included 19,23,27,14 and 6 cases respectively.And in all of the 89 cases,12 cases were combined with other organ injury: one brain damage,one pulmonary contusion,seven celiac organ injuries and three bone fractures.According to their condition,69 cases accepted conservative treatment,and the rest 20 cases accepted surgery.In the surgery cases,fifteen patients accepted nephrectomy,and five patients’ kidney were retained.The other organs injuries all accepted corresponding treatment.Results All of the 89 cases recovered from their injury and no patient died.Conclusion Bultrasound is the first examination to the renal injury and especially the emergency ones.CT is a kind of rapid and accurate examination for closed renal injury,which also plays an important role in the evaluation of the renal injury degree and the choice of the treatment.Protecting the injury kidney reasonably and positively is an effective treatment for the closed renal injury. 　　Key words:kidney injury;diagnosis;treatment 　　在腹部损伤中，肾脏损伤占8%～10%，其中70%为钝性闭合伤[1]。1996年1月～2007年12月我院共收治闭合性肾损伤89例，现报告如下。 临床资料 　　1 一般资料 　　本组89例，男性72例，女性17例;年龄9～70岁，平均34.5岁。左肾损伤58例，右肾31例。损伤原因：道路交通伤53例，坠落伤26例，钝物击伤8例，病理性肾损伤2例。合并其他脏器损伤1