Cass A S, Luxenberg M, Gleich P, Smith C S
J Urol. 1986 Aug;136(2):370-1. doi: 10.1016/s0022-5347(17)44871-3.
The evaluation of patients with blunt renal trauma has become controversial. We tested the hypothesis that renal contusion can be diagnosed clinically and that these patients do not require radiographic evaluation. To evaluate the association of microhematuria without shock and with renal contusion, we reviewed the medical records of 831 patients with hematuria following blunt renal trauma. Microscopic hematuria without shock was noted in 160 of 241 patients without and 334 of 590 with associated injuries. Of the former 160 patients 159 had renal contusion and 1 had a renal laceration, while of the latter 334 patients 329 had renal contusion, 3 had renal laceration, 1 had renal rupture and 1 had a pedicle injury. Most patients with microscopic hematuria and no shock after blunt renal trauma had a renal contusion, especially those with no associated injury. All of the patients with renal contusions experienced no complications from nonoperative management. However, avoiding a radiographic evaluation in patients with blunt renal trauma plus microhematuria and no shock would miss a few cases of severe renal injury.
钝性肾损伤患者的评估已颇具争议。我们检验了如下假说：肾挫伤可通过临床诊断，且这些患者无需进行影像学评估。为评估无休克的镜下血尿与肾挫伤之间的关联，我们回顾了831例钝性肾损伤后出现血尿患者的病历。在241例无相关损伤的患者中，160例出现无休克的镜下血尿；在590例有相关损伤的患者中，334例出现无休克的镜下血尿。在前160例患者中，159例有肾挫伤，1例有肾裂伤；而在后334例患者中，329例有肾挫伤，3例有肾裂伤，1例有肾破裂，1例有肾蒂损伤。钝性肾损伤后出现镜下血尿且无休克的大多数患者有肾挫伤，尤其是那些无相关损伤的患者。所有肾挫伤患者经非手术治疗均未出现并发症。然而，对钝性肾损伤合并镜下血尿且无休克的患者不进行影像学评估会漏诊少数严重肾损伤病例。
