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中華民國泌尿科醫學會雜誌

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篇名 Attempted Conservative Treatment in Blunt Major Renal Trauma
卷期 7:3
並列篇名 嘗試保守療法治療主要性腎臟挫傷
作者 楊志東
頁次 143-147
關鍵字 腎臟外傷保守療法renal traumaconservative treatmentTSCI
出刊日期 199609

中文摘要

從1991年7月至1993年6月,台東馬偕醫院共有18例,嚴重之挫傷性腎臟外傷的病人求診住院,所有18個病人在急診皆做了腹部電腦斷層攝影檢查,其中有10例為第三級,8例為第四級。 16個病人有肉眼可見性血尿,1例有顯微性血尿,另一例則無血尿現象,外傷的原因有16例為車禍意外,兩例則是因跌倒引起。斷我病人皆以保守療法治療,包括絕對臥床休息;血紅素及血壓之測量,高水份,抗生素及止痛劑之給予。病人平均住院日數為15.6天,有七個病人需輸血,平均輸血3.8單位。其中有兩個病人因腹部器官受傷而需做剖腹探查手術(脾臟裂傷一例,肝臟裂傷一例),所有18例病人除一例因有感染性尿囊腫而置入雙J型導管外,其餘病人皆無進一步泌尿科方面之手術處理。所有的病人在住院當中皆無高血壓的現象且病人出院時情況良好。結論:以保守療法治療嚴重之挫傷性腎臟外傷,可得到不錯之結果,病人住院之併發症低且出院後追蹤之結果不錯,緊急的腹部電腦斷層攝影是很有價值之診斷及分類的工具。手術探查應保留給腎血管有創傷及血壓不穩定的病人。

英文摘要

Treatment used for 18 patients with major blunt renal trauma is presented. Emergency computerized tomography scan was performed in all cases. There were 10 cases of Grade III and 8 cases of Grade IV injury. All of the cases were treated by conservative management which included bed rest, blood pressure and hemoglobin monitoring, high fluid intake, antibiotics and analgesics .The mean hospital stay was 15.6 days. Seven of 18 patients required transfusions (3 in Grade III, 4 in Grade IV) to a volume of 3.8 units. Two patients underwent laparotomy for associated intra-abdominal injuries (spleen rupture in one, liver laceration in another). Infected urinoma occurred in one case; double J stent was inserted for several days. There were no instances of hypertension during the hospitalization. All patients were discharged uneventfully. Follow-up renal sonogram was available in 10 patients and renal CT was available in 6 patients. All of the kidneys were functioning and only focal scarring was noted in the previously injured renal units. All the patients remained clinically asymptomatic and all the cases had normal blood pressure. In conclusion, conservative treatment resulted in an excellent outcome for all these patients. The in-hospital morbidity was minimal, and the follow-up results were good. Early surgical exploration of the blunt renal trauma should be reserved for renal pedicle injury or hemodynamic instability. Emergency CT is an invaluable tool for classifying and managing patients.