Eastham J A, Wilson T G, Ahlering T E
Department of Urology, University of Southern California Medical Center, Los Angeles.
J Urol. 1992 Aug;148(2 Pt 1):266-7. doi: 10.1016/s0022-5347(17)36566-7.
Recent reports in the literature suggest that radiographic evaluation of the normotensive blunt trauma patient with microscopic hematuria is no longer necessary. Several facilities, however, including ours, continue to perform excretory urography (IVP) routinely in this setting. To evaluate further whether this practice is indicated, we retrospectively reviewed the records of 317 adults who presented to our facility between May 1986 and December 1989 after blunt trauma with resultant microscopic hematuria but no shock. All patients were radiographically assessed with an IVP. Of the 317 studies 29 (9%) had an abnormal result, including 28 with renal contusion and 1 with a nonfunctioning kidney (in which case further evaluation revealed a congenitally absent kidney). No significant urological injury was identified. Thus, no injury would have been missed if a policy of observation had been followed in these patients. Our data support other reports in the literature that radiographic staging is not necessary in the adult blunt trauma patient with microscopic hematuria but no shock.
文献中最近的报道表明，对血压正常且有镜下血尿的钝性创伤患者进行影像学评估已不再必要。然而，包括我们机构在内的一些机构，在此种情况下仍常规进行排泄性尿路造影（IVP）。为了进一步评估这种做法是否合理，我们回顾性分析了1986年5月至1989年12月间因钝性创伤导致镜下血尿但无休克而前来我院就诊的317例成人患者的病历。所有患者均接受了IVP影像学评估。在这317例检查中，29例（9%）结果异常，其中28例为肾挫伤，1例为无功能肾（进一步评估发现为先天性肾缺如）。未发现明显的泌尿系统损伤。因此，如果对这些患者采取观察策略，不会漏诊任何损伤。我们的数据支持文献中的其他报道，即对于血压正常且有镜下血尿但无休克的成人钝性创伤患者，影像学分期并非必要。
