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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。
Objective To explore the treatment and efficacy of renal puncture wounds. Methods Thirteen patients with renal puncture wounds admitted to our hospital from March 2001 to May 2008 were retrospectively analyzed. The causes of injury, degree of injury (according to American Society of Traumatology), treatment methods and results were analyzed. Results All the 13 cases of renal injury were puncture wounds. Among them, 2 cases of grade Ⅰ ~ Ⅱ injury were treated conservatively and 4 cases of grade Ⅲ injury, of which 1 case was conservatively treated and 3 cases received renal angiography and super selective TAE was successfully stopped. Grade Ⅳ injury was performed in 6 cases. One case had TAE success with hemodynamic stability, 3 cases underwent kidney exploration and repair, 2 cases underwent nephrectomy, and 1 case underwent grade Ⅴ injury. Found with splenic injury, line left nephrectomy + splenectomy. Thirteen patients were followed up for an average of 31.5 months. Patients with conservative treatment and kidney preservation had good renal function without complication. Conclusions The conservative treatment of low- and middle-grade renal puncture wounds is more likely to be successful. Some high-grade (Ⅲ-Ⅳ) renal puncture wounds are conservative treatment or minimally invasive renal artery thrombosis with minimal trauma and avoidance of surgery Probes led to a high rate of injury to the kidneys.