Department of Surgery, The Children's Mercy Hospital and Clinics, Kansas City, MO 64108, USA.
J Pediatr Surg. 2010 Jun;45(6):1311-4. doi: 10.1016/j.jpedsurg.2010.02.109.
Blunt renal injury in children is usually managed without an operation. However, there are no published guidelines for nonoperative management. Therefore, we conducted a retrospective review to examine the natural history of these injuries and to identify potential recommendations for management.
A retrospective analysis of our most recent 12-year experience with blunt renal injury was performed.
One hundred eleven trauma patients were identified as having a renal injury. Mean age was 10.8 +/- 4.4 years with a weight of 43.1 +/- 20.8 kg and 65% of the patients were males. In patients with an isolated renal injury (n = 65), the mean length of bed rest was 3.8 +/- 1.9 days, resulting in a mean length of hospitalization of 3.8 +/- 3.1 days. There were no transfusions, and the only operation for renal trauma was a nephrectomy in a patient with existing end-stage obstructive nephropathy of that kidney. There were 15 patients discharged with persistent hematuria, none of which had long-term sequelae.
Our data suggest the risk of significant injury from blunt renal trauma is low, and clearance of hematuria is not likely an important parameter such that bed rest with serial blood and urine monitoring may not be justified. There is clearly a role for the prospective application of a more liberal management protocol.
儿童钝性肾损伤通常无需手术治疗。然而，目前尚无关于非手术治疗管理的指南。因此，我们进行了一项回顾性研究，以检查这些损伤的自然病程，并确定潜在的管理建议。
对我们最近 12 年的钝性肾损伤经验进行了回顾性分析。
共确定 111 例创伤患者存在肾损伤。平均年龄为 10.8 ± 4.4 岁，体重为 43.1 ± 20.8kg，65%的患者为男性。在孤立性肾损伤患者（n=65）中，平均卧床休息时间为 3.8 ± 1.9 天，平均住院时间为 3.8 ± 3.1 天。无输血，仅对 1 例存在该侧终末期梗阻性肾病的患者进行了肾切除术。有 15 例患者出院时仍有血尿，但均无长期后遗症。
我们的数据表明，钝性肾损伤导致严重损伤的风险较低，血尿清除可能不是一个重要的指标，因此可能不需要卧床休息并进行连续的血液和尿液监测。前瞻性应用更宽松的管理方案显然具有一定作用。
