外科-泌尿系统损害.pptVIP

Injuries to Urinary System Urinary System Kidney Ureter Bladder Urethra Injuries to urinary system About 10% of all injuries in the emergency room involve the genitourinary system Many of them are difficult to define Early diagnosis is essential to prevent serious complications Injuries to urinary system Basic Pathological change Shock Urinary extravasation Urinary obstruction (destruction) Injuries to the KIDNEY Injuries to the KIDNEY The kidney is well protected by heavy lumbar muscles, vertebral bodies, ribs, and the viscera anteriorly Injuries to the KIDNEY Direct or indirect violence at upper abdomen or flank area may cause kidney injure Injuries to the KIDNEY Fracture ribs and transverse vertebral processes may penetrate the renal parenchyma or vesculature Etiology Blunt trauma directly to the abdomen, flank, or back is the most common mechanism for 80~85% renal injuries Vehicle accidents, fights, falls, contact sports, and so on. Gunshot and knife wounds cause penetrating injuries to the kidney Blunt: 钝性 Etiology Blunt trauma: The force transmitted from the center of the impact to the renal parenchyma Deceleration: The kidney moves upward or downward,cause sudden stretch on the pedicle, acute renal artery injuries and thrombosis may occur Pathology Renal contusion (85% of cases) 肾挫伤 Subcapsular hematoma Superficial cortical lacerations Pathology Partial lacerations Injuries extend to renal capsule or collecting system Perirenal hematoma Hematuria Pathology Deep lacerations Injuries extend both renal capsule and collecting system Extravasation of urine into perirenal space Large retroperitoneal hematoma Pathology Vascular injury (less than 1% of all cases) Vascular injury of renal pedicle is rare Difficult to diagnosis Mortality is still high Emergency operation should be done for saving life Clinical findings History of trauma Symptoms Pain may be localized to one flank area or over the abdomen associated to injury Microscopic or gro