Urology Unit and Imaging Department and Cannizzaro Emergency Hospital, Catania, Italy.
BJU Int. 2012 Sep;110(5):744-8. doi: 10.1111/j.1464-410X.2011.10901.x. Epub 2012 Feb 7.
What's known on the subject? and What does the study add? Immediate surgery for major renal truma has led to a high rate of nephrectomy in comparison with an expectant management. We reviewed our case material on the management of severe blunt renal trauma in adults with emphasis on conservative management. Only shattered kidneys and pedicle avulsion required immediate surgery.
To review retrospectively the management of major blunt renal truma in adult patients admitted to our level I trauma centre.
Among 1460 blunt abdominal trauma cases collected from January 2001 to December 2010, 221 (15%) affected the kidneys. All patients, except seven who needed immediate laparotomy, underwent a computed tomography scan to stage the injuries. Renal injuries were graded according to the American Association for the Surgery of Trauma Grading System; grade 4 and 5 injuries were subclassified based on vascular or parenchymal injury.
Only 45/221 patients (20%) suffered major blunt renal trauma (21 grade 3, 18 grade 4 and six grade 5); 43% of the patients had associated lesions and 77% had gross haematuria. Nephrectomy rates were 9% for grade 3, 22% for grade 4 and 83% for grade 5 with an exploration rate of 26% for major renal trauma.
Conservative management of grade 3-5 blunt renal trauma in haemodynamically stable patients yields more favourable results with high renal salvage rate. Grade 5 injuries still result in a nephrectomy rate of more than 80%. The absence of data on long-term outcomes and a potential inclusion bias due to the retrospective nature of the data represent major limitations of this review.
回顾性分析我院成人严重钝性肾外伤的治疗方法。
2001 年 1 月至 2010 年 12 月期间我院收治的 1460 例腹部钝性创伤患者中，221 例（15%）累及肾脏。除 7 例外，所有患者均行 CT 扫描以评估伤情。采用美国创伤外科学会分级系统评估肾损伤，根据血管或实质损伤将 4 级和 5 级损伤进一步分为亚类。
221 例肾损伤患者中，仅 45 例（20%）为严重钝性肾损伤（3 级 21 例，4 级 18 例，5 级 6 例）；43%合并其他损伤，77%有肉眼血尿。3 级损伤行肾切除术率为 9%，4 级损伤为 22%，5 级损伤为 83%，严重肾损伤探查率为 26%。
血流动力学稳定的 3-5 级肾损伤患者行保守治疗可获得更好的结果，保肾率较高。5 级损伤仍有 80%以上需行肾切除术。本回顾性研究的主要局限性在于缺乏长期预后数据和因数据的回顾性而存在的潜在纳入偏倚。
