Sarychev Leonid P, Sarychev Yaroslav V, Pustovoyt Hanna L, Sukhomlin Sergiy A, Suprunenko Sergiy M
Higher State Educational Establisment Of Ukraine "Ukrainian Medical Stomatological Academy", Poltava, Ukraine.
Wiad Lek. 2018;71(3 pt 2):719-722.
Introduction: Blunt renal trauma (BRT) is a dangerous medical condition. The aim: Analysis of effectiveness of conservative and expectant treatment tactics under ultrasound and CT monitoring in patients with blunt renal trauma (BRT).
Materials and methods: The results of treatment of 81 patients with BRT during 20 years (1998-2017) were analyzed. Amount of men was 58 (71.6%), women - 23 (28.4%). Grade I trauma was seen in 37.0% of cases, grade II - in 25.9%, grade III - in 11.1%, grade IV - in 16.1% and grade V - in 9.9% of observations.
Review: Conservative tactics was effective in 67.9% of observations. In 11.1% of cases treatment was accompanied with percutaneous drainage of liquid perirenal hematoma and urohematomas (in 2 cases with formation of perirenal abscess). Indications for surgical treatment (in 21.0% of observations) were progressing perirenal hematoma, unstable hemodynamics, inefficiency of hemorrhage stop with conservative treatment. In 9 cases, the kidney was sutured. Eight patients with multiple ruptures of the kidney, damage of the kidney vessels, massive bleeding underwent nephrectomy.
Conclusions: Achievements in visualization and therapeutic technologies can avoid and, at severe trauma, reduce the surgical treatment rates in BRT. In the presence of urohematomas with the formation of perinephral abscess and development of sepsis, the method of choice is percutaneous drainage. Indications for surgical treatment are multiple parenchymal lacerations with damage of the segmental vessels and vessels of the renal hilum when the hemorrhage stop is ineffective by conservative or noninvasive methods.
引言：钝性肾损伤（BRT）是一种危险的病症。目的：分析在超声和CT监测下对钝性肾损伤（BRT）患者采用保守和观察治疗策略的有效性。
材料与方法：分析了81例钝性肾损伤患者在20年（1998 - 2017年）期间的治疗结果。男性58例（71.6%），女性23例（28.4%）。I级损伤见于37.0%的病例，II级 - 25.9%，III级 - 11.1%，IV级 - 16.1%，V级 - 9.9%。
综述：保守策略在67.9%的观察病例中有效。11.1%的病例治疗伴有经皮引流肾周血肿和尿血肿（2例形成肾周脓肿）。手术治疗的指征（21.0%的观察病例）为进行性肾周血肿、血流动力学不稳定、保守治疗止血无效。9例进行了肾脏缝合。8例肾脏多处破裂、肾血管损伤、大量出血的患者接受了肾切除术。
结论：可视化和治疗技术的进步可避免并在严重创伤时降低钝性肾损伤的手术治疗率。在存在尿血肿并形成肾周脓肿及发生脓毒症时，首选方法是经皮引流。手术治疗的指征是当保守或非侵入性方法止血无效时，存在伴有节段性血管和肾门血管损伤的多处实质撕裂伤。
