Russell R S, Gomelsky A, McMahon D R, Andrews D, Nasrallah P F
Division of Urology and Department of Surgery, Children's Hospital Medical Center of Akron, Akron, Ohio, USA.
J Urol. 2001 Sep;166(3):1049-50.
Conservative nonsurgical management of major renal trauma in children is well established. However, when blunt trauma is accompanied by significant urinary extravasation, options are less than clearly defined. Endoscopic techniques, such as stents and percutaneous drainage, have not been widely used because of small caliber. We present our experience with endoscopic management of grade IV renal trauma.
From 1983 to 1996, 15 children satisfied the criteria for grade IV renal trauma. We retrospectively reviewed the charts to assess the mechanism of injury, associated injury, treatment, hospital stay and transfusion requirement. Patients were followed clinically with blood pressure and creatinine monitoring, and by radiograph with computerized tomography.
Nine patients with isolated kidney injury were successfully treated with observation, 1 underwent early partial nephrectomy for persistent anemia and hypotension, and 5 had a urinoma, which was successfully treated with percutaneous drainage only in 2. The other 3 patients underwent cystoscopy and ureteral stent placement for high drainage output, leading to the resolution of urine leakage. In 1 patient who underwent percutaneous drainage only renovascular hypertension developed, requiring partial nephrectomy 3 months after the original injury. The remaining 13 patients had complete radiographic resolution of the injury and no evidence of hypertension.
In the pediatric population grade IV blunt renal trauma usually resolves without intervention. When a symptomatic urinoma develops, percutaneous drainage, accompanied at times by ureteral stenting provides the complete resolution of persistent urine leakage.
小儿严重肾损伤的保守非手术治疗已得到充分确立。然而，当钝性创伤伴有大量尿液外渗时，治疗选择尚不明确。由于管径较小，诸如支架置入和经皮引流等内镜技术尚未得到广泛应用。我们介绍我们采用内镜治疗Ⅳ级肾损伤的经验。
1983年至1996年，15例儿童符合Ⅳ级肾损伤标准。我们回顾性查阅病历以评估损伤机制、合并损伤、治疗方法、住院时间和输血需求。对患者进行临床随访，监测血压和肌酐，并通过计算机断层扫描进行影像学检查。
9例孤立肾损伤患者经观察成功治愈，1例因持续贫血和低血压早期行部分肾切除术，5例有尿囊肿，其中仅2例经皮引流成功治愈。另外3例患者因引流液量多接受膀胱镜检查和输尿管支架置入，尿漏得以解决。1例仅接受经皮引流的患者发生肾血管性高血压，在原损伤3个月后需行部分肾切除术。其余13例患者损伤在影像学上完全恢复，无高血压迹象。
在小儿群体中，Ⅳ级钝性肾损伤通常无需干预即可恢复。当出现有症状的尿囊肿时，经皮引流，有时辅以输尿管支架置入可使持续性尿漏完全解决。
