外伤性肾梗死的诊断及治疗  

Diagnosis and treatment of traumatic renal infarction

作　　者：王建松[1] 刘哲[1] 周强[1] 段义星[1] 袁武雄[1] 高智勇[1] 吴万瑞[1] 

机构地区：[1]湖南省人民医院泌尿外科,长沙410005

出　　处：《中华创伤杂志》2014年第6期516-519,共4页Chinese Journal of Trauma

摘　　要：目的探讨外伤性肾梗死的诊治方法，提高对外伤性肾梗死的认识水平。方法回顾性分析2008年9月-2013年2月收治的6例外伤性肾梗死患者的临床资料。其中男5例，女1例；年龄5—65岁，平均36．2岁。致伤原因：交通伤4例，高处坠落伤2例。部分肾梗死2例，全肾梗死4例。根据美国创伤外科协会肾损伤分级标准：Ⅳ级2例，Ⅴ级4例。结果3例行非手术治疗，其中1例部分肾梗死，2例全肾梗死；3例行手术探查，其中1例行肾部分切除术，1例行左肾切除并胰腺部分切除术，1例行右肾切除术，术中及术后无大出血等并发症，无患者需要输血治疗。所有患者均得到3-34个月随访。非手术治疗组部分肾梗死者患。肾无萎缩，全肾梗死者患肾出现不同程度萎缩，3例均无高血压。手术组肾功能均正常。结论增强CT为诊断外伤性肾梗死的首选检查。非手术治疗为多数情况下适宜的治疗方法，若发生感染或肾性高血压可手术切除梗死肾。Objective To investigate the diagnosis and treatment methods of traumatic renal infarction. Methods A retrospective analysis was performed on 6 cases of traumatic renal infarction treated between September 2008 and February 2013. There were 5 males and 1 female, at age of 5-65 years （ average, 36.2 years）. Causes of injury included vehicle collisions in 4 cases and high falls in 2. Out of 6 cases, segmental renal infarction was identified in 2 and total infarction in 4. According to American Association for the surgery of trauma renal trauma grading system, 2 cases were classified to grade IV and 4 to grade V. Results Three cases were managed conservatively, which showed segmental infarction in 1 case and total infarction in 2. Three cases underwent surgical exploration, followed by partial nephrectomy in 1 case, left kidney removal plus partial pancreectomy in 1 and right kidney removal in 1. There were no major complications intraoperatively or postoperatively and no cases received blood transfusion. Period of follow-up was 3-34 months. In conservative management, there were no renal atrophies in segmental renal infarction cases and some degree of atrophies in total renal infarction cases, but none presented with arterial hypertension. Conclusions Enhanced CT is the preferred diagnostic tool for evaluation of traumatic renal infarction. Conservative therapy is the optimal option for most cases, but nephrectomy is reserved for cases of infection or renal hypertension.

关 键 词：肾 创伤和损伤 梗死 

分 类 号：R692.2[医药卫生—泌尿科学]