肾脏穿刺伤救治体会

目的探索肾脏穿刺伤的救治方法及疗效。方法回顾我院2001年3月-2008年5月收治肾脏穿刺伤患者13例,就其损伤原因、损伤程度（根据美国创伤外科协会分级标准）、处理方法及结果进行分析。结果本组13例肾损伤均为利器穿刺伤,其中Ⅰ-Ⅱ级损伤2例均行保守治疗成功;Ⅲ级损伤4例,其中1例保守治疗成功,3例接受肾血管造影并行超选择性动脉栓塞（TAE）止血成功;Ⅳ级损伤6例,其中1例伴血流动力学稳定患者行TAE成功,3例接受肾脏探查修补术,2例行肾切除术;Ⅴ级损伤1例,探查发现伴脾脏损伤,行左肾切除＋脾切除术。13例获随访,平均31.5个月,保守治疗及保存肾脏患者肾功能良好,无并发症发生。结论低中级别（Ⅰ-Ⅱ）肾脏穿刺伤保守治疗成功可能性大,部分高级别（Ⅲ-Ⅳ级）肾穿刺伤患者选择保守或肾功脉栓塞等微创治疗,创伤小,且避免手术探查导致的高伤肾切除率。

Optimal management of penetrating renal injuries

Objective This study reviews our experience in the management of penetrating renal injuries. Methods The medical records of patients with penetrating renal injuries were retrospectively reviewed during a period of 8 years at our hospital. The data included injury mechanisms, injury grade （ according to American Association for the Surgery of Trauma,AAST） ,management and outcome. Results There were 13 patients,whose injury mechanisms were stab wounds. Two patients of grade Ⅰ - Ⅱ renal injuries were treated conservatively. One patient of grade Ⅲ injuries was treated conservatively and 3 of grade Ⅲ accepted angiography and super-selective transarterial embolisation（TAE）. In 6 patients with grade-Ⅳ injuries, 1 patient with stable hemodynamics accepted TAE,3 patients renal exploration and renorrhaphy,2 patients nephrectomy. One patient subjected to grade Ⅴ injuries with splenic injury required left nephrectomy and splenectomy. The function of reserved kidney was stable. There were no complications occurred at a mean follow up of 31.5 months. Conclusion Nonoperative treatment is a reasonable option for the majority of minor penetrating renal injuries as well as in some selected high-grade （ Ⅲ-Ⅳ） ones. Transarterial embolisation（TAE） provides a minimally invasive treatment option for renovascular injuries and potentially obviates the need for surgical exploration,leading to higher incidence of nephrectomy.