Heyns C F, De Klerk D P, De Kock M L
J Urol. 1985 Aug;134(2):239-42. doi: 10.1016/s0022-5347(17)47105-9.
A prospective clinical study of 54 patients with stab wounds and hematuria was conducted to evaluate the safety of selective nonoperative management compared to mandatory surgical exploration of these patients. In the absence of signs of severe blood loss, associated intra-abdominal injury or major abnormality on the excretory urogram patients were randomized to undergo mandatory surgery (group 1) or nonoperative management (group 2). Patients with signs of severe blood loss, associated intra-abdominal injury or gross abnormality on excretory urography were selected for an operation (group 3). The rate of probably needless operations (defined as minor renal injury without associated intra-abdominal lacerations) was 78 per cent in group 1 and 0 per cent in group 3. Pulmonary complications occurred in 33 per cent of the patients in group 1, 4 per cent in group 2 and 38 per cent in group 3. Despite an operation delayed renal hemorrhage occurred in 1 patient (5 per cent) in group 1 and 2 (15 per cent) in group 3, and resulted in nephrectomy in 2 of these patients. No instance of secondary hemorrhage occurred in group 2 patients. The mean length of hospitalization was 9, 5 and 11 days in groups 1 to 3, respectively. Our results indicate that the selective nonoperative management of patients with renal stab wounds can lead to a decrease in the rate of unnecessary operations, postoperative complications and length of hospitalization compared to a policy of mandatory surgical intervention.
对54例刺伤伴血尿患者进行了一项前瞻性临床研究，以评估与这些患者的强制手术探查相比，选择性非手术治疗的安全性。在没有严重失血迹象、无相关腹腔内损伤或排泄性尿路造影无重大异常的情况下，患者被随机分为接受强制手术组（第1组）或非手术治疗组（第2组）。有严重失血迹象、相关腹腔内损伤或排泄性尿路造影有明显异常的患者被选择进行手术（第3组）。第1组中可能不必要的手术（定义为轻度肾损伤且无相关腹腔内撕裂伤）发生率为78%，第3组为0%。第1组33%的患者、第2组4%的患者和第3组38%的患者发生了肺部并发症。尽管进行了手术，但第1组有1例患者（5%）、第3组有2例患者（15%）发生了延迟性肾出血，其中2例患者因此接受了肾切除术。第2组患者未发生继发性出血。第1至3组的平均住院时间分别为9天、5天和11天。我们的结果表明，与强制手术干预策略相比，肾刺伤患者的选择性非手术治疗可降低不必要手术的发生率、术后并发症及住院时间。
