外科学泌尿系统损伤课件

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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