闭合性肾损伤的诊断和治疗

目的：探讨闭合性肾损伤的诊断和治疗。方法：1993年－2001年收治闭合性肾损伤80例，行B超、IVU、CT等检查。保守治疗66例（82．5％），手术治疗14例（17．5％），其中包括2例选择性肾动脉栓塞术。结果：78例痊愈出院，肾功能正常。2例（2．5％）死亡，均为多器官损伤合并休克的患者。68例（85．0％）随访1－5年。结论：CT平扫及增强扫描检查可较准确地诊断肾损伤程度，并可同时了解腹腔脏器损伤情况，应作为重度以上肾损伤的首选检查，B超可用以轻伤者筛选诊断。肾损伤的治疗应最大程度保留肾组织，防止并发症及后遗症，除了对严重肾实质碎裂伤，肾血管严重损伤应积极进行手术治疗，以挽救患者生命；对严重肾挫伤、肾裂伤、部分肾破裂伤所致肾出血患者可选择超选择性肾动脉栓塞术。脾破裂合并左肾损伤在临床的多发性损伤中并不少，且有其特殊性，诊治得当则能迅速转危为安，反之则会延误病情。

Diagnosis and Treatment of 80 Patients with Blunt Renal Trauma

Objective: To study the diagnosis and treatment for blunt renal trauma. Methods: From 1993 to 2001, 80 cases of blunt renal trauma were admitted in our hospital, and ultrasonography, IVU and CT scan were undertaken. Non - oprative treatment was carried out in 66 (82. 5% ). Surgical management was performed in 14 (17.5% ) , and 2 of 14 cases received selective renal artery embolization. Results: 78 cases were cured, 2 patients died of shock and coexistant injury of other organs. 68 cases (85.0%) had been followed up for 1 ~ 5 years. Conclusions: CT scan was the most reliable method for evaluating the severity of the blunt renal trauma and to detect coexistant injuries of other abdominal organs. Ultrasonography was mainly adopted in cases of minor renal injury. The key point in management was to decide whether surgical exploration was needed. The aim of treatment was to preserve the viable renal tissuies as more as possible,and to avoid early or late complications. Renal contusion,laceration and part of scattered kidney may use selective renal artery embolization. The spleen rupture combined with left renal injury was not uncommon, and need special attention.