泌尿系统损伤医学课件.pptVIP

肾损伤治疗紧急治疗：着重于休克的防治非手术治疗绝对卧床病例讨论：肾损伤后卧床一周，血尿消失的患者，返家后再次出血，终致肾切除，为什么？维持血容量抗感染密切观察手术治疗开放性损伤几乎全部需要手术闭合性损伤的处理流程肾损伤闭合损伤处理流程闭合性肾损伤镜下血尿稳定不稳定肉眼血尿稳定不稳定大剂量静脉尿路造影纠正休克肾挫伤或轻型肾裂伤重型肾裂伤肾粉碎伤肾盂破裂肾不显影（肾蒂伤？）非手术治疗手术治疗非手术治疗手术探查肾动脉造影非手术治疗稳定不稳定继续非手术治疗手术治疗手术探查血压、血尿、血常规检查、局部肿块等情况是否好转伤后有无休克、昏迷、恶心、呕吐等有无休克远期并发症的处理肾周脓肿必须引流Perinephricabscessshouldbedrained肾性高血压:血管重建vascularreconstructionor肾切nephrectomy输尿管损伤UretericTrauma特点

创伤少见Ureterictraumaisuncommon医源性多见Iatrogenicinjuriescontinuetooccur妇科手术Pelvicsurgery输尿管镜UreteroscopicInjury放疗Radiationtherapy诊断病史→非常重要临床表现实验室检查影像学检查临床表现侧腹和下腹疼Flankandlowerabdominalpain肾盂肾炎pyelonephritis急性肾功能衰竭Acuterenalfailureor肾积水hydronephrosis尿漏Urineleakfromthewound腹膜炎peritonealsigns输尿管膀胱瘘uretero-vaginalfistula影像学检查ImagingsstudiesExcretoryurograms(IVU)AlargeareaofincreaseddensityinthepelvisorinanareaofretroperitoneumHydronephrosis—delayedexcretionContrastextracasationfromtheinjury超声SonographyHydronephrosisHydroureterFluidmassduetourineextravasation肾动态显像RadionuclidescanningDelayedexcretionAccumulationofcountsinthepelvisandrenalparanchyma----ureterobstructionUrinaryextravasation鉴别诊断Differentdiagnosis腹膜炎Mimicperitonitis膀胱阴道瘘Vesicovaginaland输尿管阴道瘘ureterovaginalfistulas---MethylenebluestainCystoscopy并发症Complications尿瘘Urinaryfistula输尿管梗阻Ureteralobstruction肾积水Hydronephrosis感染Renalinfection腹膜炎Peritonitis尿毒症Uremia治疗TreatmentUreteraldivision置管Stent输尿管端端吻合Ureteroureterostomy输尿管再植Neoureterocystostomy输尿管与对侧输尿管吻合TransureteroureterostomyUreteralresection修复Repair自体肾移植Autotransplantofkidney术中早期发现的处理Earlyreoperation膀胱瓣PsoashitchorBoariflap回肠代Intestinalureter经皮肾引流Percutaneousnephrostomy修补Definitiverepair肾切除Nephrectomy膀胱损伤BladderTrauma原因CauseofBladderInjury直接暴力Mostbladderinjuries--bluntforcetoafullbladder骨盆骨折15