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279例腎損傷的診治體會(huì)
彭萬(wàn)勇1
[摘要 ] 目的:提高腎損傷的診治效果。方法:回顧性分析 279例腎損傷患者的臨床診治資料。結(jié)果:血尿
260例 (占93 . 2% ) ; B超檢查 168例 ,其中 122例 (72 . 6% )有異常表現(xiàn); CT檢查 76例 ,陽(yáng)性表現(xiàn) 63例 (83 . 0% ) ;
靜脈腎盂造影檢查 80例 ,其中腎穿透?jìng)?12例 (占15 . 0% ) ,腎鈍性傷 3例 (占3 . 8% )。本組患者手術(shù)治療 57例
(20 . 4% ) ,非手術(shù)治療 222例 (79 . 6% )。死亡 10例 (3 . 6% ) ,治愈 269例 (96 . 4% )。152例 (54 . 5% )隨訪 1～3
年 ,尿常規(guī)及腎功能檢查正常。結(jié)論:尿液檢查和 B超檢查快速、 安全、 無(wú)損傷。對(duì)于有血尿的腎穿透?jìng)颊?,或
雖無(wú)血尿但高度懷疑腎損傷的患者 ,如生命體征平穩(wěn) ,接受靜脈腎盂造影檢查是必要的。CT檢查準(zhǔn)確率高 ,可同
時(shí)了解其他臟器受損程度。如果損傷嚴(yán)重 ,尤其是并發(fā)腹內(nèi)臟器受損時(shí) ,宜適時(shí)探查腎臟 ,做出相應(yīng)的外科處理。
[關(guān)鍵詞 ] 腎損傷;靜脈腎盂造影;診斷;治療
[中圖分類號(hào) ] R691 . 6 [文獻(xiàn)標(biāo)識(shí)碼 ] A [文章編號(hào) ] 10012 1420 (2005) 032 01502 03
An exper i ence with 279 ca ses of rena l trauma
PENG W anyoug
1
(
1
Depart ment of Trauma Surgery, Uni on Hos p ital, Huazhong University of Science and Technol ogy,Wuhan, 430022, China)
Abstract Objecti ve: To p resent an experience with 279 cases of renal trauma . Methods: 279 cases of renal trauma
were retr ospectively analysed . Results:Hematuria occurred in 260 cases (93 . 2% ) ; aberrant findings were observed on
ultrasonography in 122 out of 168 (72 . 6% ) and on CT scan in 63 out of 70 (90% ) ; I ntravenous pyel ogram ( I VP) was
performed in 80 patients : abnormal i mageswas obtained in 12 out of 16 patientswith penetratingwounds and in 3 out of
64 caseswith blunt injuries ; 124 patients had injuries of other organs ; open operati on was undertaken in 57 and 222 were
treated nonoperatively . 10 (2 . 2% ) died of shock and coexistant injuries of other organs, the other 269 have been cared,152 of which have been foll owed up for 1～3 years with normal urine r outine and renal functi on . Conclusi on s:Urine in2
specti on and B2 ultrasonography were si mp le、instant、reliable and harmless t o the patient ; The intravenous pyel ogram is
essential t o the patientswith hematuria and t o the higly suspected cases though without hematuria . The diagnostic rate of
CT scanning is high, which is als o hel pful in detecting any coexistant injuries . Surgicalmanagement is indicated in cases
of severe injuries, particularly, if there are other coexisting injuries of abdomen . When hematuria is gettingmore severe
and the shock of bleeding would be inevitable, the patients should receive operati on in ti me .
Key words Kidney injuries ; Intravenous pyel ogram;Diagnosis ; Therapy
我院從 1996年 10月 ～2003年 6月共收治腎
損傷患者 279例 ,現(xiàn)對(duì)其致傷原因、 病情、 診斷與治
療措施等方面總結(jié)分析如下。
1 資料與方法
1 . 1 臨床資料
本組 279例 ,男 157例 ,女 122例 ,年齡 5～67
歲 ,平均 29 . 7歲。損傷部位為左腎 134例 ,右腎
105例,雙腎 40例。損傷程度按 Sargent分類:腎挫
傷 120例 ,腎裂傷 111例 ,腎碎裂傷 39例 ,腎蒂血
管傷 9例。致傷原因?yàn)楦咛帀嬄鋫?86例 ,鈍性打
擊傷 69例 ,交通事故傷 38例 ,銳器刺傷 24例 ,其
他損傷 62例。并發(fā)傷為脾破裂 18例 ,腸管及系膜
挫裂傷 20例 ,胰腺挫裂傷 8例 ,肝破裂 5例 ,肋骨
骨折、 血?dú)庑丶皠?chuàng)傷性濕肺 28例 ,骨盆骨折 45
1
華中科技大學(xué)協(xié)和醫(yī)院創(chuàng)傷外科 (武漢 , 430022)
例,顱腦外傷 25例 ,其他骨折 20例 ......
彭萬(wàn)勇1
[摘要 ] 目的:提高腎損傷的診治效果。方法:回顧性分析 279例腎損傷患者的臨床診治資料。結(jié)果:血尿
260例 (占93 . 2% ) ; B超檢查 168例 ,其中 122例 (72 . 6% )有異常表現(xiàn); CT檢查 76例 ,陽(yáng)性表現(xiàn) 63例 (83 . 0% ) ;
靜脈腎盂造影檢查 80例 ,其中腎穿透?jìng)?12例 (占15 . 0% ) ,腎鈍性傷 3例 (占3 . 8% )。本組患者手術(shù)治療 57例
(20 . 4% ) ,非手術(shù)治療 222例 (79 . 6% )。死亡 10例 (3 . 6% ) ,治愈 269例 (96 . 4% )。152例 (54 . 5% )隨訪 1～3
年 ,尿常規(guī)及腎功能檢查正常。結(jié)論:尿液檢查和 B超檢查快速、 安全、 無(wú)損傷。對(duì)于有血尿的腎穿透?jìng)颊?,或
雖無(wú)血尿但高度懷疑腎損傷的患者 ,如生命體征平穩(wěn) ,接受靜脈腎盂造影檢查是必要的。CT檢查準(zhǔn)確率高 ,可同
時(shí)了解其他臟器受損程度。如果損傷嚴(yán)重 ,尤其是并發(fā)腹內(nèi)臟器受損時(shí) ,宜適時(shí)探查腎臟 ,做出相應(yīng)的外科處理。
[關(guān)鍵詞 ] 腎損傷;靜脈腎盂造影;診斷;治療
[中圖分類號(hào) ] R691 . 6 [文獻(xiàn)標(biāo)識(shí)碼 ] A [文章編號(hào) ] 10012 1420 (2005) 032 01502 03
An exper i ence with 279 ca ses of rena l trauma
PENG W anyoug
1
(
1
Depart ment of Trauma Surgery, Uni on Hos p ital, Huazhong University of Science and Technol ogy,Wuhan, 430022, China)
Abstract Objecti ve: To p resent an experience with 279 cases of renal trauma . Methods: 279 cases of renal trauma
were retr ospectively analysed . Results:Hematuria occurred in 260 cases (93 . 2% ) ; aberrant findings were observed on
ultrasonography in 122 out of 168 (72 . 6% ) and on CT scan in 63 out of 70 (90% ) ; I ntravenous pyel ogram ( I VP) was
performed in 80 patients : abnormal i mageswas obtained in 12 out of 16 patientswith penetratingwounds and in 3 out of
64 caseswith blunt injuries ; 124 patients had injuries of other organs ; open operati on was undertaken in 57 and 222 were
treated nonoperatively . 10 (2 . 2% ) died of shock and coexistant injuries of other organs, the other 269 have been cared,152 of which have been foll owed up for 1～3 years with normal urine r outine and renal functi on . Conclusi on s:Urine in2
specti on and B2 ultrasonography were si mp le、instant、reliable and harmless t o the patient ; The intravenous pyel ogram is
essential t o the patientswith hematuria and t o the higly suspected cases though without hematuria . The diagnostic rate of
CT scanning is high, which is als o hel pful in detecting any coexistant injuries . Surgicalmanagement is indicated in cases
of severe injuries, particularly, if there are other coexisting injuries of abdomen . When hematuria is gettingmore severe
and the shock of bleeding would be inevitable, the patients should receive operati on in ti me .
Key words Kidney injuries ; Intravenous pyel ogram;Diagnosis ; Therapy
我院從 1996年 10月 ～2003年 6月共收治腎
損傷患者 279例 ,現(xiàn)對(duì)其致傷原因、 病情、 診斷與治
療措施等方面總結(jié)分析如下。
1 資料與方法
1 . 1 臨床資料
本組 279例 ,男 157例 ,女 122例 ,年齡 5～67
歲 ,平均 29 . 7歲。損傷部位為左腎 134例 ,右腎
105例,雙腎 40例。損傷程度按 Sargent分類:腎挫
傷 120例 ,腎裂傷 111例 ,腎碎裂傷 39例 ,腎蒂血
管傷 9例。致傷原因?yàn)楦咛帀嬄鋫?86例 ,鈍性打
擊傷 69例 ,交通事故傷 38例 ,銳器刺傷 24例 ,其
他損傷 62例。并發(fā)傷為脾破裂 18例 ,腸管及系膜
挫裂傷 20例 ,胰腺挫裂傷 8例 ,肝破裂 5例 ,肋骨
骨折、 血?dú)庑丶皠?chuàng)傷性濕肺 28例 ,骨盆骨折 45
1
華中科技大學(xué)協(xié)和醫(yī)院創(chuàng)傷外科 (武漢 , 430022)
例,顱腦外傷 25例 ,其他骨折 20例 ......
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