Richards Carly R, Clark Margaret E, Sutherland Ronald S, Woo Russell K
Tripler Army Medical Center, Honolulu, HI (CRR, MEC).
Hawaii J Med Public Health. 2017 May;76(5):119-122.
Children are at higher risk of renal injury from blunt trauma than adults due to a variety of anatomic factors such as decreased perirenal fat, weaker abdominal muscles, and a less ossified thoracic cage. Non-operative management is gaining in popularity for even major injuries, although there are no universally accepted guidelines. We present a retrospective review of pediatric major blunt renal injuries (grade 3 or higher) at a children's hospital in Hawai'i over a 5-year period. Medical records were examined between January 2009 and September 2014 from Kapi'olani Medical Center for Women and Children in Honolulu, Hawai'i. Inclusion criteria were a diagnosis of renal trauma, or the diagnosis of blunt abdominal trauma with hematuria. Exclusion criteria were grade I or II renal injury or death due to an additional traumatic injury. Mechanism of injury, clinical characteristics on admission, blood product requirements, surgical interventions performed, and hospital length of stay were retrospectively analyzed. Eleven total patient records were examined, nine of which fit inclusion criteria. Uniquely, 33% of patients sustained their renal injury while surfing. No patients required laparotomy or nephrectomy, though 22% of patients received a blood transfusion and 44% of patients underwent ureteral stent placement. Non-operative management of major renal injuries in children is feasible and allows for preservation of renal tissue. A novel mechanism of surfing as a cause of major renal trauma is seen in the state of Hawai'i.
由于多种解剖学因素，如肾周脂肪减少、腹部肌肉较弱以及胸廓骨化程度较低，儿童因钝性创伤导致肾损伤的风险高于成人。尽管目前尚无普遍接受的指南，但非手术治疗对于甚至是严重损伤也越来越受欢迎。我们对夏威夷一家儿童医院5年间的小儿严重钝性肾损伤（3级或更高）进行了回顾性研究。检查了2009年1月至2014年9月期间位于夏威夷檀香山的卡皮奥拉尼妇女儿童医院的病历。纳入标准为肾创伤诊断，或伴有血尿的钝性腹部创伤诊断。排除标准为I级或II级肾损伤或因其他创伤性损伤导致的死亡。对损伤机制、入院时的临床特征、血液制品需求、实施的手术干预以及住院时间进行了回顾性分析。共检查了11份患者病历，其中9份符合纳入标准。独特的是，33%的患者在冲浪时遭受肾损伤。尽管22%的患者接受了输血，44%的患者接受了输尿管支架置入，但没有患者需要剖腹手术或肾切除术。儿童严重肾损伤的非手术治疗是可行的，并且能够保留肾组织。在夏威夷州，冲浪作为严重肾创伤的一种新机制已被发现。
