第四級腎臟鈍傷伴隨集尿系統之損傷是否總是需要泌尿處置的介入？

林柏廷¹、林友翔¹、鄭啟桐²、廖健宏²、謝奇勳²、傅志遠²、鄭有森²

¹林口長庚紀念醫院 外科部 泌尿科；²林口長庚紀念醫院 外科部 外傷急症外科

Does a Collecting System Injury with Grade IV Renal Blunt Trauma Always Need Urinary Intervention?

Po-Ting Lin¹, Yu-Hsiang Lin¹, Chi-Tung Cheng², Chien-Hung Liao², Chi-Hsun Hsieh², Chih-Yuan Fu², Yu-San Tee²

Division of Urology¹ and Trauma and Emergency Surgery², Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan

Purpose: This study aimed to identify the characteristics associated with the need for urinary intervention for a blunt renal injury with collection system involvement using a computed tomography (CT) protocol for trauma.

Materials and Methods: Abdominal CT images of patients with blunt renal injuries from 2016 to 2020 were reviewed. Patients with low-grade renal trauma, non-collecting system involvement, American Association for the Surgery of Trauma grade V shattered kidney, and emergent nephrectomy were excluded. The largest perinephric mass thickness was measured in the axial view using CT, and a cutoff value was obtained using a receiver-operating characteristic curve analysis. Risk factors for further urinary intervention were analyzed.

Results: Among the 70 patients included in this study, those with perinephric mass thicknesses <25 mm (n=36) had a significantly lower rate of urinary intervention than those with perinephric mass thicknesses ≥25 mm (0 vs. 5; p = 0.023). There was no significant difference in the follow-up durations of the groups (19 days vs. 38 days; p = 0.198). More than 90% of the perinephric mass in the <25 mm group resolved within a median follow-up duration of 38 days, whereas nearly half of the ≥25 mm group had a residual perinephric mass during a median follow-up duration of 19 days.

Conclusions: The initial CT protocol for trauma was useful for predicting the need for further urinary interventions for collecting system injuries. A perinephric mass thickness <25 mm is predictive of a low likelihood of requiring urinary intervention.