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目的探讨Ⅲ-Ⅴ级闭合性肾脏损伤的诊断和治疗要点。方法回顾性分析收治的49例Ⅲ-Ⅴ级闭合性肾脏损伤(美国创伤外科协会american association for the surgery of trauma,AAST)的临床资料。Ⅲ型28例,Ⅳ型16例,V型5例。结果保守治疗31例,手术治疗12例(肾切除8例,肾修补4例),选择肾动脉栓塞6例。治愈47例(95.9%)。结论中、重度闭合性肾脏损伤患者伤后应尽可能选择CT检查,明确损伤程度及是否合并其他脏器损伤。治疗方法取决于损伤的程度。保守治疗是治疗肾脏损伤的重要方法,选择性肾动脉栓塞治疗肾脏损伤效果可靠,避免了手术和肾切除。对部分患者必须进行手术干预,因此及时、准确、合理把握手术指征,显得非常重要。保守治疗期间应严密观察病情进展,病情无明显改善者,应及时行选择性肾动脉栓塞或手术治疗。
Objective To investigate the diagnosis and treatment points of grade Ⅲ-Ⅴ closed kidney injury. Methods The clinical data of 49 patients with grade Ⅲ-Ⅴ closed kidney injury (American association for the surgery of trauma, AAST) were retrospectively analyzed. 28 cases of type Ⅲ, 16 cases of type Ⅳ and 5 cases of type V. Results conservative treatment in 31 cases, 12 cases of surgical treatment (nephrectomy in 8 cases, 4 cases of renal repair), the choice of renal artery embolization in 6 cases. 47 cases were cured (95.9%). Conclusions CT examination should be done as far as possible in patients with moderate and severe closed renal injury, to determine the degree of injury and whether other organ injuries should be combined. Treatment depends on the extent of the injury. Conservative treatment is an important method of treatment of renal damage, selective renal artery embolization of the treatment of renal damage and reliable, to avoid surgery and nephrectomy. For some patients must undergo surgical intervention, so timely, accurate and reasonable grasp of surgical indications, it is very important. Conservative treatment should be closely observed during the progression of the disease, no significant improvement in those who should be promptly treated with selective renal artery embolization or surgery.