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目的总结闭合性肾损伤的诊治体会,提高闭合性肾损伤的诊治水平,减少肾切除率。方法189例闭合性肾损伤患者,男146例,女43例。平均年龄38岁。综合应用尿常规、B超、IVU、CT等检查,诊断闭合性肾损伤,其中合并腹腔内脏器损伤27例,合并颅脑外伤5例,合并四肢脊柱骨折13例,3例为腹腔、颅脑与腹腔、脊柱复合伤伴休克。行保守治疗156例,其中有脾破裂3例,颅脑外伤2例,四肢脊柱骨折7例;行手术治疗27例,其中行肾修补术15例,肾部分切除术5例,肾切除7例;3例行肾动脉栓塞治疗。结果3例重度闭合性肾损伤因复合伤、顽固性休克者入院不久死亡,186例痊愈出院。102例随访3个月-8年,保守治疗病例中发生肾性高血压3例,肾周尿囊肿1例,肾萎缩1例,局限性肾积水1例,手术治疗与肾动脉栓塞治疗者均无并发症。结论CT检查是闭合性肾损伤准确诊断与选择治疗方案的重要依据,Ⅲ级以上闭合性肾损伤伤后2-4周复查CT有利于肾周尿囊肿的早期发现与治疗,Ⅳ级以下闭合性肾损伤尽可能采用非手术治疗。
Objective To summarize the experience of diagnosis and treatment of closed renal injury, improve the diagnosis and treatment of closed renal injury, and reduce the rate of nephrectomy. Methods One hundred and ninety-eight patients with closed kidney injury were male with 146 males and 43 females. The average age is 38 years old. Comprehensive application of urine routine, B-ultrasound, IVU, CT and other tests to diagnose closed renal injury, including intra-abdominal visceral injury in 27 cases, with traumatic brain injury in 5 cases, with limb spine fractures in 13 cases, 3 cases of abdominal cavity, brain Combined with abdominal cavity, spinal injury with shock. In the conservative treatment of 156 cases, there were 3 cases of splenic rupture, 2 cases of craniocerebral trauma, 7 cases of limbs and spine fracture; 27 cases were treated by surgery, including 15 cases of renal repair, 5 cases of partial nephrectomy, 7 cases of nephrectomy ; 3 cases of renal artery embolization. Results 3 cases of severe closed renal injury due to combined injury, refractory shock died soon after admission, 186 patients were discharged. 102 cases were followed up for 3 months to 8 years. Three cases of renal hypertension, one case of perirenal allantomatosis, one case of renal atrophy and one case of localized hydronephrosis were included in the conservative treatment. Surgical treatment and renal artery embolization No complications. Conclusions CT examination is an important basis for the accurate diagnosis and treatment of closed renal injury. The examination of CT at 2-4 weeks after injury of grade III or higher renal injury is helpful for the early detection and treatment of perirenal alveolar cyst, Renal injury as far as possible using non-surgical treatment.