肾损伤(PPT课件)

Kidney Trauma,Department of UrologyThe Peoples Hospital of Youyang CountyJunhui Shi,Directory,BackgroundAnatomyEtiology PathologyClinical findingsTreatmentSummary,Function of the kidneyProduce urine, excrete metabolites Maintain body fluid and acid-base balance Endocrine function: Renin, prostaglandinRegulate blood pressure and balance blood lipidsEndocrine degrading hormone,Background,Injuries to urinary systemAbout 10% of all injuries in the emergency room involve the genitourinary systemMany of them are difficult to defineEarly diagnosis is essential to prevent serious complications,Background,Basic Pathological change Shock Urinary extravasation Urinary obstruction (destruction) Infection ,cost,death,Anatomy,KidneyUreterBladderUrethra,Ur,The kidney is well protected by heavy lumbar muscles, vertebral bodies, ribs, and the viscera anteriorly,Etiology,Blunt trauma directly to the abdomen, flank, or back is the most common mechanism for 8085% renal injuriesTraffic accidents, fights, falling, contact sports, and so on.,Blunt trauma: The force transmitted from the center of the impact to the renal parenchymaDeceleration: The kidney moves upward or downward,cause sudden stretch on the pedicle, acute renal artery injuries and thrombosis may occur,Direct or indirect violence at upper abdomen or flank area may cause kidney injure,Fracture ribs and transverse vertebral processes may penetrate the renal parenchyma or vasculature,Gunshot and knife wounds cause penetrating injuries to the kidney,*Pathology,Renal contusion (85% of cases)Superficial cortical lacerationsSubcapsular hematoma,Partial lacerationsInjuries extend to renal capsule or collecting systemPerirenal hematomaHematuria,Deep lacerationsInjuries extend both renal capsule and collecting systemExtravasation of urine into perirenal spaceLarge retroperitoneal hematomaHematuria,Vascular injury (less than 1% )Vascular injury of renal pedicle is rareDifficult to diagnosisEmergency operation should be done for saving lifeMortality is still high,Clinical findings,History of traumaSymptoms:Pain may be localized to one flank area or over the abdomen associated to injuryMicroscopic or gross hematuria following trauma to the abdomen or flankFever : infection,SignsShock or signs of a large loss of blood from heavy retroperitoneal bleeding may be notedPalpable mass may represent a large retroperitoneal hematoma or urinary extravasationDiffuse abdominal tendernessLower ribs fracture,Laboratory findingsRed blood cells in urine: hematuriaHematocrit may be normal initially,but a drop may be found with time pastHCT dropping represents persistent retroperitoneal bleeding and development of a large retroperitoneal hematoma,UltrasonographyEasy FastNoninvasiveWell descript the parenchyma and hematoma of kidney,Radiology,IVU(intravenous urography, excretory urography)Function of separate sidesUrinary extravasation,Enhanced CT scanAbdominal CT scan is the most direct and effective means of staging renal injuriesClearly defines parenchymal lacerations and urinary extravasationFirst choice for diagnosis renal injuries,Radiology,Plain scanning periodVenous phasePortal venous phaseArterial phaseExcretory period,Plain scanning period,Venous phase,Arterial phase,Excretory period,ArteriographyDefines major arterial and parenchyma injuriesArterial thrombosis and avulsion of the renal pedicle are best diagnosisInvasive , choose carefully,Radiology,OthersRetrograde urography : dangerous with infection, should not be chosen MRI: noninvasive, as an alternate choice,Treatment,Emergency measuresResuscitation Treatment of shock and hemorrhageEvaluation associated injuries,Minor renal injuries from blunt trauma account for 85% of cases do not require operation Renal contusion Partial laceration,*Non-operative treatmentBed rest for 24 weeksWatchful waiting : vital signs, blood, urineHydration and nutrition Antibiotics for prevent infectionSymptomatic therapy：analgesic, sedative, hemostasis,Operation indicationsPenetrating injuries: (Penetrating abdominal injury require operation, renal exploration is only an extension of this procedure)Severe blunt injuries: Deep laceration Multiple laceration Renal pedicle injuries Persistent retroperitoneal bleeding , Severe urinary extravasation ,Operation indicationsDuring non-operation treatment : Anti-Shock ineffective, or shock occurance againHematuria get more severeMass of abdominal enlarged Hemoglobin and hematocrit keep decreasingSuspicious of Abdominal organ