Hagiwara A, Sakaki S, Goto H, Takenega K, Fukushima H, Matuda H, Shimazaki S
Department of Traumatology and Critical Care Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa Mitaka-shi, Tokyo 181-8611, Japan.
J Trauma. 2001 Sep;51(3):526-31. doi: 10.1097/00005373-200109000-00017.
The purpose of this study was to evaluate the efficacy of a protocol designed to minimize the need for surgery in the management of severe blunt renal injury.
Forty-six of 752 trauma patients had evidence of renal injury on computed tomographic (CT) scan. Two patients required emergency laparotomy, and the remaining 44 patients were classified by CT scan grade using the American Association for the Surgery of Trauma classification system. Patients with CT scan grade 3 or over underwent renal angiography.
Twenty-one patients had a high-grade injury on CT scan (> or =3). Eight had angiographic evidence of extravasation from renal arterial branches and underwent transarterial embolization. One patient with a grade 5 injury had extravasation from a main renal vein and underwent immediate laparotomy. This was the only patient who required surgery for renal injury.
Surgery can be avoided in most cases of blunt renal injury. Hemodynamic instability and injury to main renal veins remain indications for surgical exploration.
本研究旨在评估一种旨在尽量减少严重钝性肾损伤治疗中手术需求的方案的疗效。
752例创伤患者中有46例在计算机断层扫描（CT）中显示有肾损伤迹象。2例患者需要紧急剖腹手术，其余44例患者根据美国创伤外科协会分类系统通过CT扫描分级。CT扫描分级为3级及以上的患者接受了肾血管造影。
21例患者CT扫描显示为高级别损伤（≥3级）。8例有肾动脉分支外渗的血管造影证据，并接受了经动脉栓塞治疗。1例5级损伤患者主肾静脉有外渗，接受了立即剖腹手术。这是唯一因肾损伤需要手术的患者。
大多数钝性肾损伤病例可以避免手术。血流动力学不稳定和主肾静脉损伤仍然是手术探查的指征。
