腎外傷42症例の検討 : 画像診断による手術適応の検討

Abstract

1988年1月～1994年9月迄に経験した腎外傷42例について検討した.治療法の選択にあたっては軽度裂傷迄のものは保存的に治療が可能であるが, 高度裂傷以上のものには外科的治療が必要となる症例が多かった.腎盂尿管造影上III以上, CT上一部分でも腎実質が造影されない, 造影剤の溢流の所見がある症例は外科的治療を念頭に置いて治療に当たることが大切と思われた

We treated 42 patients with renal trauma between 1988 and 1994. There were 18 cases of renal contusion, 12 of minor laceration, 6 of major laceration, 5 of renal rupture and 1 of major laceration with pedicle injury. Thirty-two patients were treated by conservative management, 10 were treated surgically, 9 by simple nephrectomy and 1 by partial nephrectomy. Excretory urography was performed in 27 patients. For stage evaluation, these cases were classified into 4 groups. I: The renal pelvis and calices were clearly enhanced. II: The renal pelvis was enhanced but part of the calix was not. III: The renal pelvis was not clearly enhanced and only some calices were enhanced. IV: The renal pelvis and calices were unenhanced. In addition, computerized tomography was carried out in 24 patients. We believe that cases with classification as III or IV in excretory urography, incomplete enhancement by computerized tomography, and recognized extravasation should be treated operatively.