Goff C D, Collin G R
Department of Surgery, Carilion Roanoke Memorial Hospital, Virginia 24014, USA.
Am Surg. 1998 Mar;64(3):226-30.
Appropriate management of renal trauma is controversial. Successful outcome and long term complication rates are not well defined. In an effort to evaluate management options, outcomes, and complications of renal injuries, we conducted a retrospective review of all trauma patients admitted to the trauma service from January 7, 1989 through August 31, 1995. Inpatient and outpatient charts were reviewed for type and mechanism of injury, radiologic studies utilized, method of treatment, and short and long term complications. Fifty-five patients were identified with renal injuries. Most injuries were parenchymal injuries due to blunt trauma. Only nine patients with renal artery injuries and four patients with collecting system injuries were identified. CT scan was the most commonly used study to identify renal injuries. All nine renal artery injuries were due to blunt trauma and were initially diagnosed by CT scan. Six were confirmed with arteriogram, and two with renal scans. Of the seven patients seen in follow-up (average 153 days), there were three complications: one patient with small bowel obstruction and two patients with hypertension. Among the 47 patients with parenchymal injuries, including 4 patients with collecting system injuries, there were 2 with complications: an intraoperative ureteral transection and a urinoma. Both complications were treated successfully with a ureteral stent. Five deaths occurred in the entire group; none were related to renal injury. Thirteen patients underwent laparotomy for associated injuries only. Eight patients underwent surgical treatment for their renal injury, including five nephrectomies. The nephrectomy rate among those patients who underwent laparotomy as part of their initial management was 20 per cent, versus 3 per cent for those patients initially managed nonoperatively. Thus, most renal injuries can be managed nonoperatively with a low incidence of complications. The incidence of long-term complications after renal artery injuries and the appropriate management of these patients deserves further study.
肾创伤的恰当处理存在争议。成功的治疗结果和长期并发症发生率尚无明确界定。为了评估肾损伤的处理方案、治疗结果及并发症，我们对1989年1月7日至1995年8月31日期间创伤科收治的所有创伤患者进行了回顾性研究。查阅了住院和门诊病历，以了解损伤类型和机制、所采用的放射学检查、治疗方法以及短期和长期并发症情况。共确定55例肾损伤患者。大多数损伤为钝性创伤所致的实质损伤。仅发现9例肾动脉损伤患者和4例集合系统损伤患者。CT扫描是最常用于识别肾损伤的检查。所有9例肾动脉损伤均为钝性创伤所致，最初通过CT扫描诊断。6例经动脉造影证实，2例经肾扫描证实。在接受随访的7例患者中（平均153天），出现了3例并发症：1例小肠梗阻患者和2例高血压患者。在47例实质损伤患者中，包括4例集合系统损伤患者，有2例出现并发症：1例术中输尿管横断和1例尿瘤。这两种并发症均通过输尿管支架成功治疗。整个组中有5例死亡；均与肾损伤无关。13例患者仅因合并伤接受了剖腹手术。8例患者因肾损伤接受了手术治疗，包括5例肾切除术。在最初接受剖腹手术作为初始治疗一部分的患者中，肾切除率为20%，而最初接受非手术治疗的患者中这一比例为3%。因此，大多数肾损伤可以通过非手术治疗，并发症发生率较低。肾动脉损伤后长期并发症的发生率以及对这些患者的恰当处理值得进一步研究。
