Mann Uday, Zemp Logan, Rourke Keith F
Division of Urology, University of Alberta, Edmonton, AB, Canada.
Can Urol Assoc J. 2019 Jun;13(6):E177-E182. doi: 10.5489/cuaj.5581.
Contemporary Canadian renal trauma data is lacking. Our objective is to describe 10-year outcomes of renal trauma at a Canadian level 1 trauma centre using a conservative approach.
The Alberta Trauma Registry at the University of Alberta was used to identify renal trauma patients from October 2004 to December 2014. Hospital records and imaging were reviewed to identify clinic-radiographical factors, including patient age, gender, Injury Severity Score (ISS), American Association of the Surgery for Trauma (AAST) grade, computerized tomography (CT) findings, urological interventions, length of stay, transfusion and death rates. Descriptive statistics, Chi-square, and t-tests were used when appropriate.
A total of 368 renal trauma patients were identified. Mechanism of injury was blunt trauma in 89.1% of cases, mean age was 36.2 years, and mean ISS was 30.8 (±13.6). AAST grade distribution was 16.6% (Grade 1), 22.8% (Grade 2), 36.4% (Grade 3), 20.9% (Grade 4), and 3.3% (Grade 5). Overall, 9.5% (35) of patients required urological intervention for a total of 40 treatments, including ureteral stenting (3.0%), angioembolization (3.3%), percutaneous drainage (0.3%), or open intervention including nephrectomy (2.4%) and renorrhaphy (0.5%). No Grade 1 or 2 injuries required intervention, while 1.5%, 31.2%, and 75.0% of Grade 3, 4, and 5 injuries did, respectively. The overall renal salvage rate was 97.6%, which did not differ by mechanism of injury (p=0.25). Patients with penetrating trauma were more likely to require urological intervention (20.0% vs. 8.2%; p=0.04). Of the high-grade (III-V) renal injuries identified, 15.7% (35/223) required urological intervention, 4.9% (11) required open surgical intervention, and only 4.0% (9) of patients with high-grade renal injury required nephrectomy.
The trend towards conservative treatment of renal trauma in Canada appears well-supported even in a severely injured patient population, as over 90% of patients avoid urological intervention and only 3% require operative intervention resulting in renal salvage rates of 97.6%.
目前缺乏加拿大当代肾外伤的数据。我们的目的是使用保守治疗方法描述加拿大一家一级创伤中心10年肾外伤的治疗结果。
利用阿尔伯塔大学的阿尔伯塔创伤登记处来识别2004年10月至2014年12月期间的肾外伤患者。回顾医院记录和影像学检查以确定临床放射学因素，包括患者年龄、性别、损伤严重程度评分（ISS）、美国创伤外科协会（AAST）分级、计算机断层扫描（CT）结果、泌尿外科干预措施、住院时间、输血率和死亡率。在适当的时候使用描述性统计、卡方检验和t检验。
共识别出368例肾外伤患者。损伤机制为钝性创伤的病例占89.1%，平均年龄为36.2岁，平均ISS为30.8（±13.6）。AAST分级分布为16.6%（1级）、22.8%（2级）、36.4%（3级）、20.9%（4级）和3.3%（5级）。总体而言，9.5%（35例）患者需要泌尿外科干预，共进行了40次治疗，包括输尿管支架置入术（3.0%）、血管栓塞术（3.3%）、经皮引流术（0.3%）或开放性干预措施，包括肾切除术（2.4%）和肾修补术（0.5%）。1级或2级损伤无需干预，而3级、4级和5级损伤分别有1.5%、31.2%和75.0%需要干预。总体肾挽救率为97.6%，不同损伤机制之间无差异（p=0.25）。穿透性创伤患者更有可能需要泌尿外科干预（20.0%对8.2%；p=0.04）。在已识别的高级别（III-V级）肾损伤中，15.7%（35/223）需要泌尿外科干预，4.9%（11例）需要开放性手术干预，高级别肾损伤患者中只有4.0%（9例）需要肾切除术。
即使在重伤患者群体中，加拿大肾外伤保守治疗的趋势似乎也得到了有力支持，因为超过90%的患者避免了泌尿外科干预，只有3%的患者需要手术干预，肾挽救率为97.6%。
