非手术治疗严重闭合性肾损伤38例分析

目的 评价非手术疗法在严重闭合性肾损伤中的疗效。方法 对１９９０年３月至１９９９年５月间保守治疗的３８例严重闭合性肾损伤病例进行回顾性分析。结果 ３８例病人中，３例因持续低血压。２例因特持续血尿不减轻而改行切除或半肾切除术；３３例保守治疗成功，２６例随访６～２４个月，血清ＢＵＮ及肌酐均正常，２例轻度肾积水，１例肾萎缩，１例高血压，１例发生尿性囊肿，经皮穿刺引流后消失。１９例肾脏ＥＣＴ显示患侧肾脏的

NONOPERATIVE TREATMENT OF SEVERE CLOSED RENAL INJURIES(WITH 38 CASES)

Objective To evaluate the role of nonoperative treatment in treating severe closed renal injuries.Methods 38 cases of severe closed renal injuries treated from March,1990 to May 1999 were reviewed and analyzed.Results Of the 38 patients who were managed with nonoperative treatment in the initiation, partial nephrectomy or half-nephrectomy were performed on 5 patients due to continuous hypotension(3 patients) or persistent hematuria (2 patients). While 33 cases were treated successfully with nonoperative treatment,26 of them were followed up for 6 to 24 months. All of them had normal serum BUN and creatinine. 2 cases had slight hydronephrosis, one had renal atrophy and one had hypertension.Urinoma occurred in 1 case and was closed with percutaneous drainage. In 19 patients who underwent renal ECT scanning, the function of injuried kidneys was at 18% to 43.5% (mean 35.5% of the total).Conclusion The nonoperative treatment is a safe and effective approach in managing severe closed renal injuries. It can retain the vital renal tissue in the greatest limitation without significantly increasing the incidence of complications.