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目的总结我科5年来收治的肾损伤合并严重尿外渗的处理及转归。方法对21例肾外伤伴严重尿外渗患者,通过静脉尿路造影、CT、彩超等检查确诊后,18例入院后安放伤侧输尿管支架管引流尿液并进行随访行保守治疗,3例由于血流动力学不稳定行急诊手术探查。结果21例肾外伤伴尿外渗患者17例(IV级损伤)保守治疗成功,随访5~46个月,肾功能均正常,无血尿、结石、肾性高血压等并发症的发生;3例急诊开放行肾切除术,1例Ⅱ期行部分肾切除术,所有需外科处理的患者均为高级别肾损伤IV或V级。结论肾损伤伴严重尿外渗患者(IV级损伤)早期安放输尿管内支架经保守治疗多数可获良好疗效。
Objective To summarize the treatment and prognosis of renal injury with severe urinary extravasation in our department for 5 years. Methods Twenty-one cases of renal trauma with severe exudation of urine were diagnosed by venous urography, CT and color Doppler ultrasonography. 18 cases were admitted to the hospital and ureteral stents were placed to drain the urine and were followed up for conservative treatment. In 3 cases, Hemodynamic instability in emergency surgery exploration. Results Twenty-one cases (grade IV) of 21 patients with renal trauma accompanied by extravasation were treated conservatively. All the patients were followed up for 5 to 46 months with normal renal function. No complications such as hematuria, calculi and renal hypertension occurred. Three cases Emergency open nephrectomy, 1 case of partial nephrectomy stage Ⅱ, all patients requiring surgical treatment of high-grade renal injury IV or V level. Conclusions In the early stage of renal injury with severe urinary infiltration (Grade IV injury), ureteral stents were treated conservatively and most of them achieved good results.