Department of Urology, University of California San Francisco, San Francisco, CA, USA.
Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA.
World J Urol. 2023 Jul;41(7):1983-1989. doi: 10.1007/s00345-023-04432-w. Epub 2023 Jun 25.
To investigate management trends for American Association for the Surgery of Trauma (AAST) grade V renal trauma with focus on non-operative management.
We used prospectively collected data as part of the Multi-institutional Genito-Urinary Trauma Study (MiGUTS). We included patients with grade V renal trauma according to the AAST Injury Scoring Scale 2018 update. All cases submitted by participating centers with radiology images available were independently reviewed to confirm renal trauma grade. Management was classified as expectant, conservative (minimally invasive, endoscopic or percutaneous procedures), or operative (renal-related surgery).
Eighty patients were included, 25 of whom had complete imaging and had independent confirmation of AAST grade V renal trauma. Median age was 35 years (Interquartile range (IQR) 25-50) and 23 (92%) had blunt trauma. Ten patients (40%) were managed operatively with nephrectomy. Conservative management was used in nine patients (36%) of which six received angioembolization and three had a stent or drainage tube placed. Expectant management was followed in six (24%) patients. Transfusion requirements were progressively higher with groups requiring more aggressive treatment, and injury characteristics differed significantly across management groups in terms of hematoma size and laceration size. Vascular contrast extravasation was more likely in operatively managed patients though a statistically significant association was not found.
Successful use of nonoperative management for grade V injuries is used for a substantial subset of patients. Lower transfusion requirement and less severe injury radiologic phenotype appear to be important characteristics delineating this group.
研究美国创伤外科学会（AAST）五级肾损伤的治疗趋势，重点关注非手术治疗。
我们使用前瞻性收集的数据作为多机构泌尿生殖系统创伤研究（MiGUTS）的一部分。我们根据 AAST 损伤评分量表 2018 年更新标准，纳入符合五级肾损伤的患者。对参与中心提交的所有病例进行独立影像学评估，以确认肾损伤的等级。治疗方法分为保守治疗（微创、内镜或经皮操作）和手术治疗（与肾脏相关的手术）。
共纳入 80 例患者，其中 25 例有完整影像学资料，且经独立证实为 AAST 五级肾损伤。中位年龄为 35 岁（四分位距 25-50），23 例（92%）为钝性损伤。10 例（40%）患者接受手术治疗，行肾切除术。9 例（36%）患者采用保守治疗，其中 6 例行血管栓塞治疗，3 例行支架或引流管置入。6 例（24%）患者采用期待治疗。需要输血的患者比例随着治疗方法的侵袭性增加而增加，且各组患者的损伤特征在血肿大小和撕裂大小方面存在显著差异。手术治疗患者更有可能出现血管造影剂外渗，但两者之间未发现统计学显著关联。
对于相当一部分患者，成功应用非手术治疗五级肾损伤。较低的输血需求和较轻的影像学表现的损伤特征可能是区分这组患者的重要特征。
