du Plessis Willem Meyer, du Plessis Danelo Estienne, Bruce John Lambert, Smith Michelle Td, Clarke Damian Luiz
Department of Urology, St Aidan's Hospital, 33 ML Sultan Rd, Greyville, Durban 4000, South Africa; University of KwaZulu-Natal, 201 Townbush Road, Pietermaritzburg 3200, South Africa.
cDepartment of Urology, Tygerberg Academic Hospital, Cape Town, South Africa; Faculty of Health, University of Stellenbosch, Francie Van Zijl Drive, Parow, Cape Town 7505, South Africa.
Injury. 2022 Jan;53(1):76-80. doi: 10.1016/j.injury.2021.08.016. Epub 2021 Aug 18.
Most of the data on high grade Traumatic renal injuries (TRI) has come from centres which predominantly encounter blunt trauma. Blunt and penetrating mechanisms are not analogous, and it is imprudent to blindly extrapolate management strategies between the two groups. In addition, within the broad group of penetrating mechanisms of injury there are also major differences between gunshot wounds (GSW) and stab wounds (SW). The aim of this comparative study of GSW and SW to the kidney is to quantify the impact of the mechanism of injury on nephrectomy rate in high grade TRI.
A prospective trauma registry was interrogated retrospectively. All patients sustaining a high grade (Grade III to V) penetrating TRI were included. The diagnosis was made either with cross-sectional imaging or intra-operative findings. The nephrectomy rate of the different mechanisms of penetrating (GSW vs SW) TRI was compared in each grade.
A total of 28 GSW and 27 SW causing high grade TRIs (Grade III-V) were included over the 85 months of the study. GSW lead to a higher nephrectomy rate than SWs 50.0 vs 19%, (p = 0.023). When comparing grade for grade, Grade III: 20.0 (GSW) vs 21% (SW), (p = 1). Grade IV: 71 (GSW) vs 17%, (SW) (p = 0.058) and Grade V: 100 (GSW) vs 0%, (SW) (p = 0.28). When comparing Grade IV - V together, the difference is 85 (GSW) vs 15%, (SW) (p = 0.001).
On a grade to grade comparison GSWs have a much higher risk for nephrectomy than SW's in grade IV and V TRI. TRI secondary to GSWs appears to be an independent risk factor for nephrectomy in high grade injuries. The mechanism of penetrating TRI should be considered in future management algorithms and clinical approaches.
大多数关于重度创伤性肾损伤（TRI）的数据来自主要收治钝性创伤患者的中心。钝性创伤和穿透性创伤机制并不相同，在这两类创伤之间盲目推断治疗策略是不明智的。此外，在广泛的穿透性创伤机制中，枪伤（GSW）和刺伤（SW）之间也存在重大差异。本项针对肾脏枪伤和刺伤的对比研究旨在量化损伤机制对重度创伤性肾损伤肾切除率的影响。
对前瞻性创伤登记数据进行回顾性分析。纳入所有遭受重度（III至V级）穿透性创伤性肾损伤的患者。诊断通过横断面成像或术中发现做出。比较各等级中不同穿透机制（枪伤与刺伤）的创伤性肾损伤的肾切除率。
在为期85个月的研究中，共纳入28例由枪伤导致的重度创伤性肾损伤（III - V级）患者和27例由刺伤导致的患者。枪伤导致的肾切除率高于刺伤，分别为50.0%和19%（p = 0.023）。按等级比较，III级：20.0%（枪伤）对21%（刺伤）（p = 1）。IV级：71%（枪伤）对17%（刺伤）（p = 0.058），V级：100%（枪伤）对0%（刺伤）（p = 0.28）。将IV级和V级一起比较时，差异为85%（枪伤）对15%（刺伤）（p = 0.001）。
在等级对比中，在IV级和V级创伤性肾损伤中，枪伤导致肾切除的风险远高于刺伤。枪伤导致的创伤性肾损伤似乎是重度损伤中肾切除的独立危险因素。在未来的治疗方案和临床方法中应考虑穿透性创伤性肾损伤的机制。
