Resch Thomas R, Kufera Joseph A, Chiu William, Scalea Thomas M
Am Surg. 2019 Mar 1;85(3):266-272.
Present literature seems to support the nonoperative management of penetrating renal trauma although data remain limited. We conducted a nine-year retrospective review of nonoperative operative management and mechanism of injury [stab wound (SW) gunshot wound (GSW)] among patients admitted with penetrating renal trauma. Of 203 patients, the median age was 24 years, with the majority being male and having GSW injuries. More than half (52.2%) were treated nonoperatively (69.9% of SW and 40% of GSW injured patients). When compared with all operative patients combined, nonoperative patients had a lower median Injury Severity Score (17 26, < 0.001), lower transfusion requirement (27.4% 77.3%, < 0.001), shorter median hospital stay (4.7 12.6 days, < 0.001), and lower mortality (1.9% 13.4%, = 0.002). Gunshot wound patients had a higher median Injury Severity Score (26 14, < 0.001), higher median American Association for the Surgery of Trauma-Organ Injury Score (3 2, = 0.001), greater need for transfusion (69.2% 29.3%, < 0.001), longer median hospital length of stay (12.1 3.9 days, < 0.001), and greater mortality (12.5% 0%, < 0.001) than SW patients. Nonoperative management of penetrating renal injury is safe in selected patients. In addition, renal GSW injuries are associated with a greater morbidity and mortality.
目前的文献似乎支持穿透性肾损伤的非手术治疗，尽管相关数据仍然有限。我们对因穿透性肾损伤入院的患者进行了为期九年的非手术、手术治疗及损伤机制（刺伤[SW]、枪伤[GSW]）的回顾性研究。在203例患者中，中位年龄为24岁，大多数为男性且有枪伤。超过一半（52.2%）的患者接受了非手术治疗（SW损伤患者的69.9%和GSW损伤患者的40%）。与所有手术患者相比，非手术患者的中位损伤严重程度评分更低（17对26，P<0.001），输血需求更低（27.4%对77.3%，P<0.001），中位住院时间更短（4.7天对12.6天，P<0.001），死亡率更低（1.9%对13.4%，P = 0.002）。枪伤患者的中位损伤严重程度评分更高（26对14，P<0.001），中位美国创伤外科学会器官损伤评分更高（3对2，P = 0.001），输血需求更大（69.2%对29.3%，P<0.001），中位住院时间更长（12.1天对3.9天，P<0.001），死亡率更高（12.5%对0%，P<0.001）。对于部分患者，穿透性肾损伤的非手术治疗是安全的。此外，肾GSW损伤与更高的发病率和死亡率相关。
