McGahan J P, Richards J R, Jones C D, Gerscovich E O
Department of Radiology, University of California, Davis, Medical Center, Sacramento 95817, USA.
J Ultrasound Med. 1999 Mar;18(3):207-13; quiz 215-6. doi: 10.7863/jum.1999.18.3.207.
The purpose of this study was to assess the use of emergent ultrasonographic examination in acute traumatic renal injuries. Over a 3 year period, prospective data of all patients who had an emergency ultrasonogram were recorded. Thirty-two patients with 37 renal injuries were studied retrospectively to identify in how many patients the sonogram detected free fluid or a renal parenchymal abnormality. Free fluid in the abdomen was identified in 19 of 32 patients (59%). However, 12 of these 19 patients had concomitant injury, such as splenic rupture requiring splenectomy, severe liver lacerations, or bowel lacerations requiring repair, that were possible causes of the free fluid. Eliminating these patients, only seven of 20 patients with isolated renal injuries had free fluid in the abdomen (35%), whereas 13 of 20 patients (65%) had no evidence of free fluid. All seven patients with free fluid had moderate or severe renal injuries. Renal parenchymal abnormalities were identified on ultrasonograms in eight of 37 (22%) of injured kidneys. The abnormalities were detected more commonly in cases of severe injury (60%). In conclusion, acute injuries of the kidney from blunt abdominal trauma often are associated with significant splenic, hepatic, or bowel trauma. Isolated renal injuries frequently occur without the presence of free fluid in the abdomen. Furthermore, the ultrasonogram of the kidney often is normal with acute renal injuries, but it is more likely to be abnormal with severe (grade II or greater) renal injuries. Sonography may be used in the triage of patients with blunt abdominal trauma and possible renal injury. However, a negative ultrasonogram does not exclude renal injury, and, depending on clinical and laboratory findings, other imaging procedures such as computed tomography should be performed.
本研究的目的是评估急诊超声检查在急性创伤性肾损伤中的应用。在3年的时间里，记录了所有接受急诊超声检查患者的前瞻性数据。对32例有37处肾损伤的患者进行回顾性研究，以确定超声检查在多少患者中检测到游离液体或肾实质异常。32例患者中有19例（59%）在腹部发现游离液体。然而，这19例患者中有12例伴有其他损伤，如需要脾切除的脾破裂、严重肝裂伤或需要修复的肠裂伤，这些可能是游离液体的原因。排除这些患者后，20例单纯肾损伤患者中只有7例（35%）腹部有游离液体，而20例患者中有13例（65%）没有游离液体的证据。所有7例有游离液体的患者均有中度或重度肾损伤。37处受伤肾脏中有8处（22%）在超声检查中发现肾实质异常。这些异常在严重损伤病例中更常见（60%）。总之，腹部钝性创伤导致的急性肾损伤常伴有严重的脾、肝或肠创伤。单纯肾损伤常发生且腹部无游离液体。此外，急性肾损伤时肾脏超声检查常为正常，但重度（Ⅱ级或以上）肾损伤时更可能异常。超声检查可用于腹部钝性创伤和可能肾损伤患者的分诊。然而，超声检查结果阴性并不能排除肾损伤，应根据临床和实验室检查结果进行其他影像学检查，如计算机断层扫描。
