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ID:18643729
大小:5.27 MB
页数:42页
时间:2018-09-20
《外科学泌尿系统损伤课件》由会员上传分享,免费在线阅读,更多相关内容在教育资源-天天文库。
1、泌尿系统损伤UrologicTraumaGeneralConsiderationsIatrogenicInjuryExternalTraumaRenalTraumaAnatomyIatrogenicRenalInjuryExternalRenalInjuriesSpontaneousRetroperitonealHemorrhageReasonsBluntrenalinjuriesmostoftencomefrommotorvehicleaccidents,fallsfromheights,andassau
2、lts.Penetratingrenalinjuriesmostoftencomefromgunshotandstabwounds.PercutaneousRenalProceduresdecelerationinjuryPresentationHematuriaisthebestindicatoroftraumaticurinarysysteminjuryHowever,thedegreeofhematuriaandtheseverityoftherenalinjurydonotcorrelatecons
3、istently:inupto36%ofrenalvascularinjuriesfromblunttrauma,hematuriaisabsentClassificationI挫伤肉眼或镜下血尿其他泌尿系检查正常血肿包膜下血肿II血肿腹膜后肾周血肿撕裂伤<1cm的肾皮质裂伤,无尿外渗III撕裂伤>1cm的肾皮质裂伤,无尿外渗及集合系统损伤IV撕裂伤肾皮质、髓质和集合系统全层裂伤血管肾动脉或静脉主干损伤伴出血V撕裂伤肾碎裂血管肾蒂撕脱伤,肾无血供IndicationsforRenalImagingallbl
4、unttraumapatientswithgrosshematuriaandpatientswithmicroscopichematuriaandshock(systolicbloodpressure<90mmHganytimeduringevaluationandresuscitation)shouldundergorenalimaging,usuallyCTwithintravenouscontrast.Patientswithmicroscopichematuriawithoutshockcanbeo
5、bservedclinicallywithoutimagingstudies.Penetratinginjurieswithanydegreeofhematuriashouldbeimaged.Ultrasonographyisapopularimagingmodalityintheinitialevaluationofabdominaltrauma.NonoperativeManagementindeed,98%ofbluntrenalinjuriescanbemanagednonoperatively.
6、GradeIVandVinjuriesmoreoftenrequiresurgicalexploration.Patientswithhigh-gradeinjuries(gradesIIItoV)selectedfornonoperativemanagementshouldbeobservedcloselyTheisolatedrenalinjury,withoutsignificantassociatedinjuries,occursmorecommonlyfromblunttraumaandinmos
7、tcircumstancescanbemanagednonoperatively.TheexceptionismajorgradeVvascularpedicleavulsioninjuries.Isolatedrenalinjurieswithparenchymallacerationsandevensegmentalarterialinjurycanhaveactivebleedingwellcontrolledbyangiographicembolization.OperativeManagement
8、Absoluteindicationsincludeevidenceofpersistentrenalbleeding,expandingperirenalhematoma,andpulsatileperirenalhematoma绝对适应症包括:持续性肾脏出血、肾周血肿扩大及肾周搏动性血肿Relativeindicationsincludeurinaryextravasation,nonviabletissue
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