泌尿系损伤.ppt

泌尿系损伤 （urinary system injury）,outline,泌尿系损伤中，最为常见的尿道损伤，肾和膀胱损伤次之，输尿管损伤较少见,泌尿系损伤中最主要的表现是出血(haemorrhagia)和尿外渗(urinary extravasation),classify,肾损伤（Kidney injury）,Text in here,Kidney injury,Text in here,Kidney injury,Text in here,Etiology,肾损伤分类,closed injury,肾 挫 伤,肾挫伤并包膜下血肿,closed injury,肾部分裂伤,肾皮质裂伤、肾周血肿,closed injury,肾全层裂伤,肾全层裂伤、肾周广泛血肿,closed injury,肾广泛裂伤,肾广泛裂伤,closed injury,肾血管损伤,肾蒂断裂,closed injury,肾盂输尿管移行处损伤,肾盂输尿管移行处损伤、尿囊形成,Clinical presentation,腰痛（ lumbodynia ）,血尿（ hemuresis ）,休克 （shock）,腹部包块（mass）,发热（fever）,diagnosis,diagnosis,肾挫伤 肾包膜下血肿,diagnosis,IVU示左肾挫伤、尿外渗,diagnosis,肾 蒂 断 裂,diagnosis,腹部钝挫伤 动脉造影示左肾动脉急性血栓形成,diagnosis,肾动脉造影,treatment,1.绝对卧床4-6周,2.密切观察生命体征变化,3.补充血容量及热量，维持水电解质平衡,4.抗生素预防感染,5.应用止血、镇痛、镇静药物,treatment： surgery,手术适应症(operation indication ),3,1.开放性肾损伤：几乎所有开放性肾损伤病人 都需行手术探查,treatment,surgery,4,1.经腹切口，先处理腹腔损伤脏器，然后 阻断肾蒂血管，探查肾脏。,2.根据损伤情况，可选择： 肾修补 肾部分切除 肾切除 选择性肾动脉栓塞术,treatment,5,Complications,输尿管损伤（Ureteral injury）,Text in here,Ureteral injury,Ureteral injury,diagnosis,diagnosis,排泄性尿路造影 IVP 尿外渗,treatment,膀胱损伤（bladder injury）,Text in here,bladder injury,Etiology,开放性： 火器、利刃,闭合性： 直接暴力 间接暴力,医源性： 器械操作 手术、放疗,自发性破裂： 病理性膀胱 结核、肿瘤等,bladder injury,classify,bladder injury,Clinical presentation,bladder injury,1.history and examination,导尿检查(catheterization )：注入200-300ml生理盐水，吸出液体量差异大,CT,X线：膀胱造影,diagnosis,膀胱破裂 （腹膜外）,bladder injury,腹膜内型膀胱破裂 造影剂包围肠袢,bladder injury,treatment,尿道损伤（Urethral injury）,Text in here,Urethral injury,Text in here,男性尿道长而弯曲,Urethral injury,Text in here,女性尿道宽 短 直,Urethral injury,Urethral injury,（一）,前尿道损伤 （anterior urethral injury）,多发生于球部，骑跨伤,anterior urethral injury,前尿道损伤尿外渗范围,anterior urethral injury,尿道出血(hemuresis)：最常见,局部血肿(swelling)、瘀斑(ecchymosis ),疼痛（pain）,排尿困难(dysuria ),4,1,2,3,尿外渗(Urinary extravasation)：可引起脓毒血症,5,Clinical presentation,4,anterior urethral injury,X线,诊断性导尿,病史及体检,diagnosis,anterior urethral injury,骑跨伤导致球部尿道断裂 尿道造影示尿外渗部位,anterior urethral injury,尿道断裂 (Urethral disruption ),尿道端端吻合,如能导尿，留置导尿2周。导尿失败，则手术缝合裂口,尿道破裂 (urethra rupture ),止血止痛、抗生素、 必要时导尿,尿道挫伤 (urethral contusion ),抗休克、尽早手术,紧急处理(first aid),tratment,尿道损伤（Urethral injury）,（二）,后尿道损伤 （posterior urethral injury ）,多发生于骨盆骨折,posterior urethral injury,后尿道损伤尿外渗范围 （尿生殖膈完整）,posterior urethral injury,后尿道损伤尿外渗范围 （尿生殖膈破裂）,posterior urethral injury,Clinic