CAJ | 학술논문

目的探讨创伤性肾包膜下血肿的发病原因及诊断、治疗方法.方法回顾性分析11例创伤性肾包膜下血肿患者的临床资料,其中外伤性肾包膜下血肿4例,医源性肾包膜下血肿7例,包括体外冲击波碎石术(ESWL)后4例、输尿管镜下碎石术后2例、经皮肾穿刺活检术后1例.分别给予保守治疗、B超引导下经皮穿刺引流治疗及开放手术治疗.结果 11例中保守治疗4例,B超引导下经皮穿刺引流治疗6例,手术探查1例.保守治疗及B超引导下经皮穿刺引流治疗10例中的7例获随访1～3年,愈后良好,未发现肾性高血压、肾功能受损、肾积水、肾脏化脓性感染等并发症.手术探查1例因肾包膜下血肿和肾创伤严重术中出血行病变肾脏切除术.结论创伤性肾包膜下血肿多发生于腰腹部撞击. 伤,医源性创伤如ESWL、输尿管镜下碎石术、经皮肾穿刺活检术等操作后.CT和B超检查是创伤性肾包膜下血肿主要诊断方法.创伤性肾包膜下血肿保守治疗及B超引导下经皮穿刺引流治疗可取得良好的效果,应尽量避免开放手术治疗.
목적 탐토창상성신포막하혈종적발병원인급진단、치료방법.방법 회고성분석11례창상성신포막하혈종환자적림상자료,기중외상성신포막하혈종4례,의원성신포막하혈종7례,포괄체외충격파쇄석술(ESWL)후4례、수뇨관경하쇄석술후2례、경피신천자활검술후1례.분별급여보수치료、B초인도하경피천자인류치료급개방수술치료.결과 11례중보수치료4례,B초인도하경피천자인류치료6례,수술탐사1례.보수치료급B초인도하경피천자인류치료10례중적7례획수방1～3년,유후량호,미발현신성고혈압、신공능수손、신적수、신장화농성감염등병발증.수술탐사1례인신포막하혈종화신창상엄중술중출혈행병변신장절제술.결론 창상성신포막하혈종다발생우요복부당격. 상,의원성창상여ESWL、수뇨관경하쇄석술、경피신천자활검술등조작후.CT화B초검사시창상성신포막하혈종주요진단방법.창상성신포막하혈종보수치료급B초인도하경피천자인류치료가취득량호적효과,응진량피면개방수술치료.
Objective To investigate the cause and treatment experience for traumatic renal subcapsular hematoma.Methods The data of eleven cases with traumatic renal subcapsular hematoma were reviewed.four cases were caused by external injury,and seven cases were iatrogenic,including four cases of postESWL patients,two cases of post-ureteroscopic lithotripsy patients and one case after percutaneous renal biopsy.The patients were treated with conservative treatment,percutaneous drainage of the hematoma and surgical exploration,respectively.Results Four cases received conservative treatment,six cases received percutaneous drainage of the hematoma,and one case received surgical exploration.Seven of the ten cases who received conservative treatment or percutaneous drainage of the hematoma were continuously followed up for 1 to 3 years.They recovered well without complications such as renal hypertension,renal function impairment,hydronephrosis and renocortical pyogenic infection.One case was performed nephrectomy due to severe trauma and hemorrhage during the surgical exploration.Conclusion Traumatic renal subcapsular hematoma usually occurs after flank abdomen injury,iatrogenic injury such as ESWL,ureteroscopic lithotripsy and percutaneous renal biopsy.CT and ultrasound examination are the major means to diagnose traumatic renal subcapsular hematoma and determine the severity.Optimistic prognosis can be obtained after conservative treatment and percutaneous drainage of the hematoma.Surgical exploration should be avoided as far as possible.