Wein A J, Arger P H, Murphy J J
J Trauma. 1977 Sep;17(9):662-6. doi: 10.1097/00005373-197709000-00002.
Eighty-five cases of blunt renal trauma evaluated radiographically at our institution were reviewed. Thirty-eight patients had normal urograms; 47 demonstrated one or more of the following urographic findings: poor visualization, extravasation, intrarenal hematoma, perirenal hematoma, and kidney rupture. Nineteen arteriograms and twelve renal explorations were performed. Three explorations were negative; two were followed by repair of a laceration, three by nephrectomy, and four by heminephrectomy. A review of the factors of influencing the choice of surgical treatment and of the results obtained in patients who did not undergo surgery supports the recommendation of conservative management for stable patient. In the absence of clinical deterioration, neither the presence of extravasation nor the demonstration of renal fracture is an adequate indication for surgery. Angiography is useful to further document and classify renal injuries but is unnecessary for the conservative management of the stable patient. When surgery is contemplated, angiography is useful for surgical planning and for the exclusion of injury to adjacent structures, but it should not supplant clinical judgment in determining whether surgery is necessary.
我们回顾了在本机构接受影像学评估的85例钝性肾外伤病例。38例患者尿路造影正常；47例有以下一种或多种尿路造影表现：显影不佳、外渗、肾内血肿、肾周血肿和肾破裂。进行了19次血管造影和12次肾脏探查。3次探查结果为阴性；2次随后进行了裂伤修复，3次进行了肾切除术，4次进行了半肾切除术。对影响手术治疗选择的因素以及未接受手术患者的治疗结果进行回顾后发现，对于病情稳定的患者，支持采取保守治疗的建议。在无临床病情恶化的情况下，外渗的存在或肾骨折的显示均不足以作为手术指征。血管造影有助于进一步记录和分类肾损伤，但对于病情稳定患者的保守治疗并非必需。当考虑进行手术时，血管造影有助于手术规划和排除对相邻结构的损伤，但在确定是否有必要进行手术时，不应取代临床判断。
