Lent V
Department of Urology, St. Nikolaus Stiftshospital, Academic Teaching Hospital, University of Bonn, Andernach, Germany.
Eur Urol. 1996;30(3):327-34. doi: 10.1159/000474191.
The objective of this paper is to attain an adequate consideration of the relevant factors in conventional classifications of renal trauma and to work out a differentiated classification with a simple trauma formula suitable for both scientific purposes and for clinical decision-making.
Previous classifications of renal trauma were evaluated retrospectively to establish whether and to what extent all criteria have been considered which may be important for the outcome of kidney trauma. The pathogenesis, the locations and the symptoms of the injuries with their degrees served as principal parameters.
From 1950 to 1991, a minimum of 24 classifications of renal trauma with different criteria has been used. In 54.2% of these, blunt and perforating injuries were not distinguished. Injuries of the renal pelvis or the vascular system were not considered in 62.9 and 8.3% of these, respectively. The degrees of severity ranged from 2 to 6 (on average, 3.5). In 87.5%, there was a combination with the injury location (renal pelvis, vascular system). Finally, of 29 definable criteria, an average of only 9.6 was specified, i.e. most were not evaluated at all.
It is concluded that most of the previous classifications of renal trauma neither clearly distinguish between nor adequately differentiate their individual factors. This may be a major reason for the persistence of controversies with regard to concepts of therapy, since they are based on inadequate definitions of comparative studies. A more differentiated PLS classification is proposed comprising the following elements: the pathogenesis P1 (blunt injuries), P2 (perforating injuries), the locations of the injuries LA (parenchyma), LB (renal pelvis), LC (vascular system) with their degrees of injury LA 0-7, LB 0-2, LC 0-9, and the symptoms of injury SA (hemorrhage), SB (extravasation of urine), SC (kidney damage) with their degrees of severity SA 0-3, SB 0-3, SC 0-3 as prognostic factors. The new classification incorporated in a simple trauma formula may enable more precise scientific investigation and also facilitate clinical decisions, so that patients with kidney trauma can be treated more specifically.
本文的目的是充分考虑肾创伤传统分类中的相关因素，并制定一种差异化分类方法，采用一个简单的创伤公式，适用于科学研究目的和临床决策。
对既往肾创伤分类进行回顾性评估，以确定是否以及在何种程度上考虑了所有可能对肾创伤预后重要的标准。损伤的发病机制、部位和症状及其程度作为主要参数。
1950年至1991年期间，至少使用了24种不同标准的肾创伤分类。其中54.2%未区分钝性伤和穿透伤。分别有62.9%和8.3%的分类未考虑肾盂或血管系统损伤。严重程度范围为2至6级（平均3.5级）。87.5%的分类将损伤部位（肾盂、血管系统）与损伤程度相结合。最后，在29个可定义的标准中，平均仅明确了9.6个，即大多数标准根本未被评估。
得出的结论是，既往大多数肾创伤分类既未明确区分其各个因素，也未对其进行充分区分。这可能是治疗理念方面争议持续存在的主要原因，因为这些争议基于比较研究的不充分定义。提出了一种更具差异化的PLS分类方法，包括以下要素：发病机制P1（钝性伤）、P2（穿透伤）；损伤部位LA（实质）、LB（肾盂）、LC（血管系统）及其损伤程度LA 0 - 7、LB 0 - 2、LC 0 - 9；损伤症状SA（出血）、SB（尿液外渗）、SC（肾损伤）及其严重程度SA 0 - 3、SB 0 - 3、SC 0 - 3作为预后因素。纳入简单创伤公式的新分类方法可能有助于更精确的科学研究，也便于临床决策，从而能更有针对性地治疗肾创伤患者。
