Heyns C F, de Klerk D P, de Kock M L
J Urol. 1983 Aug;130(2):228-31. doi: 10.1016/s0022-5347(17)51077-0.
The clinical records of 67 patients who underwent surgical exploration for stab wounds associated with hematuria were reviewed in an attempt to evaluate the need for mandatory operation and to define criteria for possible nonoperative of such cases. Minor renal injuries without associated intra-abdominal lacerations were found in 61 per cent of the patients. Delayed renal hemorrhage occurred in 15 per cent of the patients despite early exploration, suture and drainage of the kidney, and antibiotic prophylaxis. Of 7 nephrectomies 5 were performed for secondary hemorrhage. Postoperative pulmonary complications arose in 28 per cent of the patients. A policy of mandatory operation on all patients with stab wounds and hematuria led to apparently needless surgery in 61 per cent of the patients in this series. Retrospective analysis revealed that the rate of probably unnecessary operations could have been reduced to 24 per cent by selecting for operation only those patients with signs of severe hemorrhage, associated intra-abdominal injury or major extravasation of contrast material on excretory urography.
回顾了67例因刺伤伴血尿而接受手术探查患者的临床记录，旨在评估强制手术的必要性，并确定此类病例可能采取非手术治疗的标准。61%的患者存在无腹腔内裂伤的轻度肾损伤。尽管早期对肾脏进行了探查、缝合、引流及预防性使用抗生素，但仍有15%的患者发生延迟性肾出血。在7例肾切除术中，有5例是因继发性出血而进行的。28%的患者出现术后肺部并发症。对所有刺伤伴血尿患者实施强制手术的策略，导致该系列中61%的患者接受了明显不必要的手术。回顾性分析显示，仅选择那些有严重出血迹象、合并腹腔内损伤或排泄性尿路造影显示造影剂大量外渗的患者进行手术，可能不必要的手术率可降至24%。
