泌尿系统损伤

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病因与病理
开放性损伤 闭合性损伤 轻度肾损伤 重度肾损伤 肾血管损伤
临床上最多见 一般不需手术治疗
需迅速确诊并急诊手术
II I Parenchymal year III
IV
V
Pelvic ear Perirenal hematomAavulsion of pedicle
肾损伤的类型
临床表现
腹腔穿刺
有典型腹膜刺激症或有移动性浊音时 以除外腹内脏器损伤
• B超
肾损伤 renal trauma
诊断diagnosis
– Advantages are that it (1) is noninvasive, (2) may be performed in real time in concert with resuscitation, and (3) may help define the anatomy of the injury.
• Disadvantages of IVP are that (1) it requires multiple images for maximal information (2) the radiation dose is relatively high (0.0070.0548 Gy); (3) a full IVP usually requires a trip to the radiology suite; and (4) findings do not reveal the full extent of injury
– Disadvantages are that (1) it requires intravenous contrast in order to maximize information about functionality, hematoma, and, possibly, bleeding; (2) the patient must be stable enough to go to the scanner; and (3) full urinary assessment is dependent on the timing of contrast and scanning in order to view the bladder and ureters.
泌尿系损伤
Baidu Nhomakorabea
肾损伤 输尿管损伤 膀胱损伤 尿道损伤
泌尿系统损伤特点
发生部位多见于男性尿道 在发达地区或战时则以肾损伤多见
肾 输尿管 膀胱 后尿道部位深
不易受伤
但在严重外伤时多以复合伤形式多见
泌尿系损伤主要病理表现 出血和尿外渗
早期确诊,正确的初期处理,对愈后极为重要
肾损伤
肾位置较深,受腰肌 椎体 肋骨和前面的 脏器保护且肾周围脂肪囊有一定活动度,不易 受到损伤但肾实质脆,包膜薄,受暴力打击时会 发生破裂
肾损伤 renal trauma
诊断diagnosis
Grade 3 renal laceration on abdominal radiograph. Abdominal radiograph after intravenous contrast administration shows very diminished left nephrogram and no urinary contrast extravasation.
肾损伤 renal trauma
诊断diagnosis
– 静脉肾盂造影 • In the era before CT scans, this modality provided the most detailed information on renal anatomy. the traditional IVP should not, in general, be used in the urgent evaluation of renal trauma.
休克 血尿 疼痛 腰腹部肿块 发热
诊断
病史及体格检查 严重胸腹内脏损伤症状可掩盖泌尿症状 需加以注意
化验检查 尿Rt Hb HCV 必要时多次重复
诊断
特殊检查
确定损伤部位程度有无尿外渗 肾血管损伤及对肾情况
除紧急手术者外条件允许下行
B超 CT MRI X-ray K.U.B. 平片 I.V.P.等
– Disadvantages are that (1) optimal study results related to anatomy require an experienced sonographer; (2) the focused abdominal sonography for trauma, (3) bladder injuries may be missed
肾损伤 renal trauma
诊断diagnosis
Sonogram in an 8-year-old child with posttraumatic renal infarction shows both kidneys with an avascular area in the lower half of the affected kidney
• Advantages of IVP are that it (1) allows functional and anatomic assessment of both kidneys and ureters, (2) establishes the presence or absence of 2 functional kidneys, and (3) may be performed in the emergency department or operating room.
肾损伤 renal trauma 肾损伤 renal traum诊a断diagnosis
诊断diagnosis
CT
– Advantages are that it (1) allows unsurpassed functional and anatomic assessment of the kidneys and urinary tract, (2) helps establish the presence or absence of 2 functional kidneys, and (3) allows for the diagnosis of concurrent injuries.
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