闭合性肾损伤临床诊治体会(附125例报告)

目的探讨闭合性肾损伤病人的诊断及治疗效果。方法对我科在1979年1月-2002年12月收治125例闭合性肾损伤进行回顾性分析。本组非手术治疗101例（80．8％），包括其中肾动脉栓塞治疗3例；手术治疗24例（19．2％，）其中肾切除12例，肾修补10例及肾部分切除2例。结果本组静脉尿路造影（IVU）检查64例，阳性46例；B超检查48例，阳性41例；CT检查59例，阳性59例。本组平均住院时间23．5d。122例治愈，3例死于合并伤，其中2例死于早期顽固性休克，另1例死于脑干损伤。随访37例，随访2-18月，定期复查尿常规、IVU及血压均正常。结论B超检查便捷，可快速初步判断伤情．CT能较准确快速判断肾损伤程度及并发胸腔腹部脏器伤的发现，对肾损伤分型及指导治疗有重要作用。肾损伤大部分可保守治疗，严重损伤需手术治疗。

Experience in the diagnosis and treatment of closed renal trauma (A report of 125 cases)

Objective To investigate the diagnosis and therapeutic efficacy of closed renal injury. Methods From January 1979 to December 2002,125 cases with close renal injuries were analyzed retrospectively. Among them, 101 cases underwent non operative treatment,including 3 cases of renal arterial embolization,and 24 cases underwent operative treatment,including nephrectomy 12 cases, renal repair 10 cases and partial nephrectomy 2 cases. Results In this group, 64 cases underwent intravenous urography and 46 cases were positive. 48 cases underwent ultrasonography and 41 cases were positive. 59 cases underwent CT scan examination and all cases were positive. Average hospitalization was 23.5 days. 122 cases were cured. 3 cases died, 2 cases died of early refractory shock and other 1 case died of brain-stem injury. Follow-up was got in 37 cases. Follow-up time was from 2 to 18 months. The examination of urinary routine, IVU and blood pressure were normal during periodic examination. Conclusion The（B mode） ultrasonography and CT scan examination are very important to diagnose the typing of renal injury and guides the treatment. Most of renal injury may perform conservative treatment. However, the operative treatment is neccessary for severe injury of kidney.