创伤性肾包膜下血肿的诊治体会

目的总结创伤性肾包膜下血肿的临床特点及诊疗策略。方法选择18例创伤性肾包膜下血肿病例,其中外伤性肾包膜下血肿13例,医源性肾包膜下血肿5例,分析CT和B超检查结果,分别选择保守治疗、B超引导下经皮穿刺引流治疗和手术探查治疗。结果18例中选择保守治疗11例,选择微创治疗5例,手术探查2例。2例手术探查者由于肾包膜下血肿和肾创伤严重均实施肾切除术。保守治疗和微创治疗的16例随访1～5年,14例愈后良好,保守治疗组有2例在1年后复查有不同程度的肾萎缩,患肾功能减低。18例均无肾性高血压、肾积水和肾脏感染的发生。结论医源性肾包膜下血肿是由于诊疗过程中操作不规范所致,13例外伤性肾包膜下血肿,有9例肾合并有其它肾脏疾病,CT和B超检查是诊断肾包膜下血肿并明确血肿严重程度的主要检查方法,根据肾包膜下血肿的严重程度分别选择保守治疗和微创治疗可取得良好的治疗效果,应严格掌握手术探查指征。

Diagnosis and management of traumatic renal subcapsular hematoma

Objective To summarize the clinical characteristics and treatment method for diagnosis and treatment of traumatic renal subcapsular hematoma. Methods Totally 18 cases of traumatic renal subcapsular hematoma （ 13 cases due to external injury and 5 iatrogenic cases ） were treated with conservative treatment,minimally invasive treatment and surgical exploration respectively according to the results of CT and US examination. Results Conservative treatment, minimally invasive treatment and surgical exploration were undertaken respectively in 11 cases ,5 cases and 2 cases. Two cases with surgical exploration underwent nephrectomy due to traumatic renal sub- capsular hematoma and serious renal wound. Other 16 cases including 11 cases with surgical exploration and 5 ca- ses with minimally invasive therapy were followed up for 1-5 years, and good prognosis was obtained in 14 cases. Two cases in the conservative treatment group were found renal atrophy to some extent and renal function decreased after 1 year. Renal hypertension,hydronephrosis and renal infection were not detected in all cases. Conclusion I- atrogenic renal subcapsular hematoma is due to irregular manipulation of diagnosis and treatment ~ and traumatic renal subcapsular hematoma is always complicated with other renal diseases. CT and ultrasound examination are the major means to detect renal hematoma and determine severity degree. Good curative effect can be obtained if conservative treatment and minimally invasive treatment are selected according to the severity degree of renal hematoma. Surgical exploration indication should be strictly mastered.