Erlich Tomer, Kitrey Noam D
Department of Urology, The Chaim Sheba Medical Center, Tel Hashomer, Israel.
Department of Urology, The Chaim Sheba Medical Center, 2 Sheba Road, Tel Hashomer, 5262100, Israel.
Ther Adv Urol. 2018 Jul 10;10(10):295-303. doi: 10.1177/1756287218785828. eCollection 2018 Oct.
The kidneys are the most vulnerable genitourinary organ in trauma, as they are involved in up to 3.25% of trauma patients. The most common mechanism for renal injury is blunt trauma (predominantly by motor vehicle accidents and falls), while penetrating trauma (mainly caused by firearms and stab wound) comprise the rest. High-velocity weapons impose specifically problematic damage because of the high energy and collateral effect. The mainstay of renal trauma diagnosis is based on contrast-enhanced computed tomography (CT), which is indicated in all stable patients with gross hematuria and in patients presenting with microscopic hematuria and hypotension. Additionally, CT should be performed when the mechanism of injury or physical examination findings are suggestive of renal injury (e.g. rapid deceleration, rib fractures, flank ecchymosis, and every penetrating injury of the abdomen, flank or lower chest). Renal trauma management has evolved during the last decades, with a distinct evolution toward a nonoperative approach. The lion's share of renal trauma patients are managed nonoperatively with careful monitoring, reimaging when there is any deterioration, and the use of minimally invasive procedures. These procedures include angioembolization in cases of active bleeding and endourological stenting in cases of urine extravasation.
肾脏是创伤中最易受损的泌尿生殖器官，在创伤患者中占比高达3.25%。肾损伤最常见的机制是钝性创伤（主要由机动车事故和跌倒引起），其余为穿透性创伤（主要由火器伤和刺伤引起）。高速武器由于能量高和附带效应，会造成特别严重的损伤。肾创伤诊断的主要依据是增强计算机断层扫描（CT），所有出现肉眼血尿的稳定患者以及出现镜下血尿和低血压的患者均需进行此项检查。此外，当损伤机制或体格检查结果提示肾损伤时（如快速减速、肋骨骨折、侧腹瘀斑以及腹部、侧腹或下胸部的任何穿透伤），也应进行CT检查。在过去几十年中，肾创伤的治疗方法不断演变，明显朝着非手术治疗的方向发展。大多数肾创伤患者采用非手术治疗，包括密切监测、病情恶化时重新进行影像学检查以及采用微创手术。这些手术包括对活动性出血病例进行血管栓塞，对尿外渗病例进行腔内泌尿外科支架置入术。
