Robert M, Drianno N, Muir G, Delbos O, Guiter J
Urology Department, Lapeyronie University Hospital, Montpellier, France.
Eur Urol. 1996;30(3):335-9. doi: 10.1159/000474192.
To evaluate changes in the management of major blunt renal trauma since the introduction of computerized tomographic diagnosis and follow-up.
Twenty-three consecutive patients with deep blunt renal lacerations without major pedicle injury or shattered kidney were treated from 1986 to 1995. In group 1 (1986-1989, 12 patients), initial management was conservative, but with open surgery in cases of hemodynamic instability or persistent urinary extravasation. In group 2 (1990-1995, 11 patients), a plain conservative approach was followed and open surgery was reserved for major complications only.
In group 1, 6 patients required early renal exploration (4 nephrectomies, 2 renorrhaphies). A persistent urinary fistula led to late nephrectomy in 1 of the renorrhaphy patients. Retroperitoneal hematoma and urinary extravasation spontaneously resolved in 6 cases. Length of hospital stay was significantly lower (p = 0.02) for nonoperated patients. None suffered from hypertension at long-term follow-up (5-8 years, mean 7.2). In groups 2, all 11 patients were treated conservatively, with endoscopic ureteric stenting in 4 cases. Urinary extravasation always resolved, but 9 patients had residual perirenal hematoma at the time of discharge. Length of hospital stay was significantly higher (p = 0.0005) with ureteric stenting. Nine months after trauma, 1 patient suffered from recurrent pyelonephritis. Radiographic follow-up (1-30 months, mean 10.2) revealed minor sequelae in all evaluated patients.
In most patients with major blunt renal lacerations, a conservative approach is safe. Most extravasation spontaneously resolves and minimally invasive techniques will deal with nearly all complications. In our experience, open surgery usually results in nephrectomy.
评估自引入计算机断层扫描诊断及随访以来，严重钝性肾损伤治疗方法的变化。
1986年至1995年连续收治23例无主要肾蒂损伤或肾破裂的深度钝性肾裂伤患者。第1组（1986 - 1989年，12例患者），初始治疗为保守治疗，但血流动力学不稳定或持续性尿外渗的患者采用开放手术。第2组（1990 - 1995年，11例患者），采用单纯保守治疗方法，仅对主要并发症采用开放手术。
第1组，6例患者需要早期肾脏探查（4例行肾切除术，2例行肾缝合术）。1例肾缝合术患者因持续性尿瘘导致后期肾切除术。6例患者的腹膜后血肿和尿外渗自行消退。非手术患者的住院时间显著缩短（p = 0.02）。长期随访（5 - 8年，平均7.2年）无一例发生高血压。第2组，11例患者均接受保守治疗，4例患者行内镜输尿管支架置入术。尿外渗均得到解决，但9例患者出院时仍有肾周血肿残留。输尿管支架置入术患者的住院时间显著延长（p = 0.0005）。创伤9个月后，1例患者发生复发性肾盂肾炎。影像学随访（1 - 30个月，平均10.2个月）显示所有评估患者均有轻微后遗症。
大多数严重钝性肾裂伤患者采用保守治疗是安全的。大多数尿外渗可自行消退，微创技术几乎可处理所有并发症。根据我们的经验，开放手术通常导致肾切除术。
