钝性肾动脉损伤的管理与医院治疗结果：来自国家创伤数据库的517例患者分析
Management and hospital outcomes of blunt renal artery injuries: analysis of 517 patients from the National Trauma Data Bank.
作者信息
Sangthong Burapat, Demetriades Demetrios, Martin Matthew, Salim Ali, Brown Carlos, Inaba Kenji, Rhee Peter, Chan Linda
机构信息
Division of Trauma and Critical Care, Department of Surgery, School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
出版信息
J Am Coll Surg. 2006 Nov;203(5):612-7. doi: 10.1016/j.jamcollsurg.2006.07.004. Epub 2006 Sep 27.
BACKGROUND
Blunt renal artery injuries are rare and no single trauma center can accumulate substantial experience for meaningful conclusions about optimal therapeutic strategies. The purpose of this study was to assess the incidence of renal artery injuries after different types of blunt trauma, and evaluate the current therapeutic approaches practiced by American trauma surgeons and the effect of various therapeutic modalities on hospital outcomes.
STUDY DESIGN
This was a National Trauma Data Bank study including all blunt trauma admissions with renal artery injuries. Demographics, mechanism of injury, Injury Severity Score, Abbreviated Injury Score for each body area (head, chest, abdomen, extremities) injuries, type of management (nephrectomy, arterial reconstruction, or observation), time from admission to definitive treatment, and hospital outcomes (mortality, ICU, and hospital stay) were analyzed. Multiple and logistic regression analyses were used to examine the relationship between type of management and hospital outcomes.
RESULTS
Of a total of 945,326 blunt trauma admissions, 517 patients (0.05%) had injuries to the renal artery. Of the 517 patients, the kidney was not explored in 376 (73%), 95 (18%) patients had immediate nephrectomy, and 45 (9%) patients underwent surgical revascularization. In 87 of 517 (17%) patients, renal artery injury was the only intraabdominal injury. Of the 87 patients with isolated renal artery injuries, 73 (84%) were observed, 7 (8%) underwent surgical revascularization, and 7 (8%) had early nephrectomy. Multiple regression analysis demonstrated that patients who had surgical revascularization had a considerably longer ICU and hospital stay than observed patients. Patients who had nephrectomy had a considerably longer hospital stay than observed patients.
CONCLUSIONS
Blunt renal artery injury is rare. Nonoperative management should be considered as an acceptable therapeutic option.
背景
钝性肾动脉损伤较为罕见，没有任何一个创伤中心能够积累足够丰富的经验，从而就最佳治疗策略得出有意义的结论。本研究的目的是评估不同类型钝性创伤后肾动脉损伤的发生率，评价美国创伤外科医生目前采用的治疗方法以及各种治疗方式对医院治疗结果的影响。
研究设计
这是一项国家创伤数据库研究，纳入了所有伴有肾动脉损伤的钝性创伤入院病例。分析了人口统计学资料、损伤机制、损伤严重程度评分、每个身体部位（头部、胸部、腹部、四肢）损伤的简明损伤评分、治疗方式（肾切除术、动脉重建术或观察）、从入院到确定性治疗的时间以及医院治疗结果（死亡率、重症监护病房停留时间和住院时间）。采用多元回归分析和逻辑回归分析来研究治疗方式与医院治疗结果之间的关系。
结果
在总共945,326例钝性创伤入院病例中，517例患者（0.05%）发生了肾动脉损伤。在这517例患者中，376例（73%）未进行肾脏探查，95例（18%）患者立即接受了肾切除术，45例（9%）患者接受了手术血管重建术。在517例患者中的87例（17%）中，肾动脉损伤是唯一的腹腔内损伤。在这87例孤立性肾动脉损伤患者中，73例（84%）接受了观察，7例（8%）接受了手术血管重建术，7例（8%）进行了早期肾切除术。多元回归分析表明，接受手术血管重建术的患者在重症监护病房和住院的时间比接受观察的患者长得多。接受肾切除术的患者住院时间比接受观察的患者长得多。
结论
钝性肾动脉损伤较为罕见。非手术治疗应被视为一种可接受的治疗选择。
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