44例闭合性肾损伤的诊疗体会.docVIP

44例闭合性肾损伤的诊疗体会 目录 TOC \o 1-9 \h \z \u 目录 1 正文 1 文1：44例闭合性肾损伤的诊疗体会 1 1 一般资料 2 2 临床症状、体征及辅助检查 3 3 诊断 3 1 致伤原因 3 2 肾损伤的诊断 4 3 治疗方案 5 文2：闭合性肾损伤的诊断和治疗 6 1 临床资料 6 2 讨论 7 参考文摘引言： 10 原创性声明（模板） 11 文章致谢（模板） 11 正文 44例闭合性肾损伤的诊疗体会 文1：44例闭合性肾损伤的诊疗体会 Abstract： Objective To propose an update viewpoint for treating closed renal trauma,so as to improve the effectiveness of diagnosis and Data on 44 cases of closed renal trauma were retrospectively Right renal trauma was found in 20 cases,left renal trauma in 21 cases，double renal trauma in 3 occurred in 38 out of 43 cases(%).Abnormal imaging manifestation was observed in 23 out of 34 cases(%) on ultrasonography and on CT scan in 36 out of 40 cases(90%).There were 16 cases of injury of other was undertaken in 5 cases(%),and the othe were treated was no dead of 44 cases were cured,and 19 cases were followed up for 1260 months with normal urine,blood pressure and renal Urine routine,Bultrasonography and CT scan are safe and noninvasive is precised,which is beneficial to determine the degree of 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，平均岁。住院天数4～47天，平均住院天。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例有血尿者38例(%)，其中肉眼血尿31例(%)，镜下血尿7例(%)。来诊患者均诉伤侧肾区或腰部疼痛明显，轻重不等。体格检查均查见腰部肾区明显叩击痛，部分严重病例肾区饱满。合并休克5例，受伤当时或者伤后昏迷及意识模糊2例。诊断性腹腔穿刺4例，抽到不凝血2例，无异常表现2例。入院后血压持续降低并波动3例。B超检查34例，其中23例(%)有异常表现;CT检查40例，阳性表现36例(90%)。尿常规检查44例，其中38例显示尿中红细胞有不同程度的增多。 3 诊断 根据患者外伤史、受伤部位、临床症状及体征、尿常规检查以及超声CT影像学检查