Li YunPeng, Xiao Long, Xu WanChao, Zhao Liangyun, Xiao MinHui
Department of Urology, The Fourth People's Hospital of Yunnan Province, Dali 671000, China.
Department of Urology, Yunnan First People's Hospital, Kunming 650000, China.
Evid Based Complement Alternat Med. 2022 Sep 22;2022:5066278. doi: 10.1155/2022/5066278. eCollection 2022.
Since the introduction of the ALARA ("as low as reasonably achievable") concept, the management of severe renal trauma has shifted. Our hospital promotes delayed surgical intervention for grade IV closed renal injury, to preserve renal function. In this study, we retrospectively reviewed the management and outcomes of patients with grade IV closed renal injury in our hospital.
To evaluate the management and outcome of grade IV closed renal injury.
We retrospectively reviewed the medical records of 45 patients with grade IV closed renal injury; namely, 36 men and 9 women with an average age of 35.6 years. All patients were diagnosed with grade IV closed renal injury in accordance with the guidelines of the American Association for the Surgery of Trauma. All hemodynamically-stable patients with renal trauma were treated conservatively for approximately 13 days and then underwent surgery only to clear the perirenal hematoma and not to repair or resect the affected kidney. Abstracted data included patient demographics, mechanism of injury, admission hemodynamics, CT findings, and mortality. The primary outcome was the success rate of nonsurgical treatment, and the secondary outcome was the complication of nonsurgical treatment.
All patients responded and were discharged, and no patients died. We followed 35 (77.8%) patients for at least 1 year. One patient with partially devitalized renal parenchyma underwent surgery to remove the affected kidney. Eleven patients (31.4%) suffered complications, namely, three (8.6%) cases of hypertension, four (11.4%) cases of hematuria, two cases (5.7%) of urinary tract infection, and two (5.7%) cases of urinoma.
Delayed exploratory surgery only to remove the hematoma should be considered in hemodynamically-stable patients with grade IV closed renal injury. This approach can avoid high nephrectomy rates associated with emergency surgery and reduce the complications that result from conservative treatment without surgery.
自引入“尽可能合理地降低（辐射剂量）”（ALARA）概念以来，严重肾创伤的管理方式发生了转变。我院提倡对IV级闭合性肾损伤采取延迟手术干预，以保留肾功能。在本研究中，我们回顾性分析了我院IV级闭合性肾损伤患者的治疗及预后情况。
评估IV级闭合性肾损伤的治疗及预后。
我们回顾性分析了45例IV级闭合性肾损伤患者的病历；其中男性36例，女性9例，平均年龄35.6岁。所有患者均根据美国创伤外科协会的指南被诊断为IV级闭合性肾损伤。所有血流动力学稳定的肾创伤患者均接受了约13天的保守治疗，然后仅接受手术以清除肾周血肿，而非修复或切除患肾。提取的数据包括患者人口统计学资料、损伤机制、入院时的血流动力学情况、CT检查结果及死亡率。主要结局为非手术治疗的成功率，次要结局为非手术治疗的并发症。
所有患者均有反应并出院，无患者死亡。我们对35例（77.8%）患者进行了至少1年的随访。1例肾实质部分坏死的患者接受了手术切除患肾。11例（31.4%）患者出现并发症，即3例（8.6%）高血压、4例（11.4%）血尿、2例（5.7%）尿路感染及2例（5.7%）尿囊肿。
对于血流动力学稳定的IV级闭合性肾损伤患者，应考虑仅为清除血肿而进行延迟探查手术。这种方法可避免与急诊手术相关的高肾切除率，并减少非手术保守治疗导致的并发症。
