From the Ohio State Medical Center (C.D.M.), Columbus, Ohio; Department of Urology (J.M.H., H.W., B.B.V.), University of Washington Medical Center; and Harborview Injury Prevention and Research Center (J.W., H.W., B.B.V.), Seattle, Washington.
J Trauma Acute Care Surg. 2013 Oct;75(4):602-6. doi: 10.1097/TA.0b013e3182a53ac2.
The National Trauma Data Bank was used to analyze open surgical management of renal trauma during the first 24 hours of hospital admission, excluding those who were treated with conservative measures. A descriptive analysis of initial management trends following renal trauma was also performed as a secondary analysis.
With the use of the National Trauma Data Bank, patients with renal injuries were identified, and Abbreviated Injury Scale (AIS) codes were stratified to a corresponding American Association for the Surgery of Trauma (AAST) renal injury grade. Trends in initial management were assessed using the following initial treatment categories: observation, minimally invasive surgery, and open renal surgery. Analysis of initial open surgery was further examined according to etiology of injury (blunt vs. penetrating), type of open renal surgery, concomitant abdominal surgery, patient demographics, and time to surgery.
A total of 9,002 renal injuries (0.3%) were mapped to an AAST renal grade. Of these, 1,183 patients underwent open surgery for their renal injury in the first 24 hours. There were 773 penetrating and 410 blunt injuries within this cohort. The majority of surgical patients sustained a high-grade renal injury (AAST Grades 4-5, 64%). The overall nephrectomy rate in the first 24 hours was 54% and 83% for the penetrating and blunt groups, respectively. While the overall nephrectomy rate for AAST Grade 1 to 3 renal injuries in the first 24 hours was low (1.8%), the nephrectomy rate was higher in the setting of an exploratory laparotomy (30%). Of those undergoing renal surgery in the first 24 hours, 86% had concomitant surgery performed for other abdominal injuries. Mean time from emergency department presentation to surgery was less for penetrating trauma.
Of the patients requiring open surgery for renal trauma within 24 hours of admission, nephrectomy is the most common surgery. Continued effort to reduce nephrectomy rates following abdominal trauma is necessary.
Epidemiologic study, level III.
本研究利用国家创伤数据库（National Trauma Data Bank）分析了入院后 24 小时内接受开放性手术治疗的肾损伤患者，排除了接受保守治疗的患者。本研究还对肾损伤的初始治疗趋势进行了二次分析。
本研究利用国家创伤数据库（National Trauma Data Bank）确定了肾损伤患者，并根据损伤的简明损伤定级（Abbreviated Injury Scale，AIS）代码分层为相应的美国创伤外科学会（American Association for the Surgery of Trauma，AAST）肾损伤分级。使用以下初始治疗类别评估初始治疗的趋势：观察、微创治疗和开放性肾手术。根据损伤病因（钝性或穿透性）、开放性肾手术类型、同期腹部手术、患者人口统计学特征和手术时间进一步分析初始开放性手术。
共确定了 9002 例（0.3%）与 AAST 肾分级相对应的肾损伤患者。其中，1183 例患者在入院后 24 小时内接受了开放性手术治疗。在这一组中，773 例为穿透伤，410 例为钝性伤。大多数手术患者存在严重肾损伤（AAST 分级 4-5 级，64%）。在 24 小时内，总体肾切除术率为 54%，穿透伤组为 83%，钝性伤组为 83%。虽然 24 小时内 AAST 分级 1-3 级肾损伤的肾切除率较低（1.8%），但在剖腹探查时，肾切除率更高（30%）。在 24 小时内接受肾手术的患者中，86%的患者同时接受了其他腹部损伤的手术治疗。穿透伤患者从急诊科就诊到手术的平均时间较短。
在入院后 24 小时内需要接受开放性手术治疗的肾损伤患者中，肾切除术是最常见的手术。需要继续努力降低腹部创伤后的肾切除率。
III 级流行病学研究。
