闭合性肾损伤76例临床诊疗分析.docVIP

闭合性肾损伤76例临床诊疗分析　　作者：马剑平,吕 菁 作者单位：深圳市南山区慢性病防治院骨科;2.深圳市第二人民医院骨科，广东 深圳 518028 　　【摘要】 目的：探讨闭合性肾损伤的诊断与治疗原则。方法：对1996年1月～2007年9月收治的76例闭合性肾损伤患者的临床资料进行回顾性分析。行B超、CT、静注尿路造影(IVU)检查者分别为65例(85.52%)、58例(76.31%)、18例(23.68%)。保守治疗64例(84.21%)，手术治疗12例(15.79%),其中保肾手术7例。结果： 治愈74例,死亡2例,其中1例合并骨盆骨折失血过多死亡,1例因合并颅脑损伤死亡。结论： B超和CT检查可迅速诊断并正确评估肾脏损伤程度。合理保肾是闭合性肾损伤的有效治疗方法。 　　【关键词】 肾;损伤;超声检查;体层摄影术，X线计算机 　　Diagnosis of closed kidney injury in 76 cases 　　MA Jianping1, LV Jing2 　　(1.Department of Orthopedics, Nanshan District Hospital for Prevention and Control of Chronic Diseases; Shenzhen 518028, China; 2.Department of Orthopedics, Shenzhen Second Peoples Hospital, Shenzhen 518028, China ) 　　[ABSTRACT] Objective: To study the diagnosis and principle of treatment of closed renal injury. Methods: Clinical data of 76 patients with closed renal injury from January 1996 to September 2007 were studied retrospectively. Ultrasound, CT and intravenous urography (IVU) were used for 65 cases (85.52%), 58 cases (76.31%) and 18 cases (23.68%) respectively. 64 cases (84.21%) underwent conservative treatment ;12 cases (15.79%) underwent surgery, of which seven were treated by kidney sparing surgery. Results: Seventy-four cases were cured and 2 cases died, of which one died of excessive blood lose because of pelvic fractures, another died of coexisted head injury. Conclusion: Ultrasound and CT examination can diagnose renal injury promptly and evaluate correctly the extent of injury. Reasonable kidney sparing surgery is an effective treatment for closed renal injury. 　　[KEY WORDS] Kidneys; Injury; Ultrasonic examination; Tomography, Xray computed 　　1996年1月～2007年9月收治闭合性肾损伤76例,现就其诊断和治疗的有关问题分析如下。 　　1 资料与方法 　　1.1 一般资料 　　本组76例。男性52例,女性24例，年龄15～68(平均35)岁。左肾损伤40例,右肾损伤26例，双肾损伤10例。合并有其他部位损伤18例。临床表现有肉眼血尿62例,镜下血尿69例,无血尿7例。腰腹部疼痛、叩击痛74例,伤侧腹膜刺激征28例,腰腹部饱满或包块33例,出现不同程度的休克症状6例,有腹部移动性浊音6例。 　　1.2 诊断与治疗方法 　　通过影像学检查了解肾损伤程度。76例中有61例做肾B超检查，肾挫裂伤36例,碎裂伤16例,肾周围血肿9例。大剂量静脉肾盂造影(IVU)18例,显示造影剂外溢11例,CT检查58例,均提示肾挫裂伤。76例损伤患者，64例行保守治疗，12例行手术治疗。 　　2 结