外科學(xué)-泌尿系統(tǒng)損傷-課件

泌尿系統(tǒng)損傷

UrologicTrauma1ppt課件GeneralConsiderationsIatrogenicInjuryExternalTrauma2ppt課件RenalTraumaAnatomyIatrogenicRenalInjuryExternalRenalInjuriesSpontaneousRetroperitonealHemorrhage3ppt課件ReasonsBluntrenalinjuriesmostoftencomefrommotorvehicleaccidents,fallsfromheights,andassaults.

Penetratingrenalinjuriesmostoftencomefromgunshotandstabwounds.PercutaneousRenalProcedures4ppt課件decelerationinjury5ppt課件PresentationHematuriaisthebestindicatoroftraumaticurinarysysteminjury

However,thedegreeofhematuriaandtheseverityoftherenalinjurydonotcorrelateconsistently:inupto36%ofrenalvascularinjuriesfromblunttrauma,hematuriaisabsent6ppt課件ClassificationI挫傷肉眼或鏡下血尿其他泌尿系檢查正常血腫包膜下血腫II血腫腹膜后腎周血腫撕裂傷<1cm的腎皮質(zhì)裂傷，無尿外滲III撕裂傷>1cm的腎皮質(zhì)裂傷，無尿外滲及集合系統(tǒng)損傷IV撕裂傷腎皮質(zhì)、髓質(zhì)和集合系統(tǒng)全層裂傷血管腎動脈或靜脈主干損傷伴出血V撕裂傷腎碎裂血管腎蒂撕脫傷，腎無血供7ppt課件

8ppt課件IndicationsforRenalImagingallblunttraumapatientswithgrosshematuriaandpatientswithmicroscopichematuriaandshock(systolicbloodpressure<90mmHganytimeduringevaluationandresuscitation)shouldundergorenalimaging,usuallyCTwithintravenouscontrast.

Patientswithmicroscopichematuriawithoutshockcanbeobservedclinicallywithoutimagingstudies.Penetratinginjurieswithanydegreeofhematuriashouldbeimaged.

Ultrasonographyisapopularimagingmodalityintheinitialevaluationofabdominaltrauma.9ppt課件10ppt課件NonoperativeManagementindeed,98%ofbluntrenalinjuriescanbemanagednonoperatively.GradeIVandVinjuriesmoreoftenrequiresurgicalexploration.Patientswithhigh-gradeinjuries(gradesIIItoV)selectedfornonoperativemanagementshouldbeobservedcloselyTheisolatedrenalinjury,withoutsignificantassociatedinjuries,occursmorecommonlyfromblunttraumaandinmostcircumstancescanbemanagednonoperatively.TheexceptionismajorgradeVvascularpedicleavulsioninjuries.Isolatedrenalinjurieswithparenchymallacerationsandevensegmentalarterialinjurycanhaveactivebleedingwellcontrolledbyangiographicembolization.11ppt課件OperativeManagementAbsoluteindicationsincludeevidenceofpersistentrenalbleeding,expandingperirenalhematoma,andpulsatileperirenalhematoma

絕對適應(yīng)癥包括：持續(xù)性腎臟出血、腎周血腫擴(kuò)大及腎周搏動性血腫Relativeindicationsincludeurinaryextravasation,nonviabletissue,delayeddiagnosisofarterialinjury,segmentalarterialinjury,andincompletestaging.相對適應(yīng)癥包括：尿外滲、組織壞死、延遲診斷的動脈創(chuàng)傷、腎段動脈創(chuàng)傷及分級不明確12ppt課件RenalExploration13ppt課件RenalReconstruction14ppt課件RenalReconstruction15ppt課件IndicationsforNephrectomyGradeVrenalinjury(77%)Theunstablepatient,withlowbodytemperatureandpoorcoagulation,cannotriskanattemptatrenalrepairifanormalcontralateralkidneyispresent(23%)16ppt課件ComplicationsPersistenturinaryextravasationcanresultinurinoma,perinephricinfection,andrenalloss.Delayedrenalbleedingcanpotentiallyoccurseveralweeksafterinjurybutusuallyoccurswithin21days.Perinephricabscess-PercutaneousdrainageHypertension:1)renalvascularinjury,leadingtostenosisorocclusionofthemainrenalarteryoroneofitsbranches;2)compressionoftherenalparenchymawithextravasatedbloodorurine;3)post-traumaarteriovenousfistula.Intheseinstances,therenin-angiotensinaxisisstimulatedbypartialrenalischemia,resultinginhypertension17ppt課件UreteralinjuriesIatrogenicUreteralInjuryExternalUreteralInjury18ppt課件IatrogenicUreteralInjuryOpenSurgeryLaparoscopicSurgeryUreterorenoscopyRadioactiveinjury19ppt課件ExternalUreteralInjuryUreteralinjuriesafterexternalviolencearerareOpeninjuryblunttraumapatientswithureteralinjuriesaresubjecttoextremeforceappliedovertheentirebody.Thegreatdegreeofenergyimpartedtothevictimisassociatedwithsuchuncommoninjuriesasfracturedlumbarprocesses

andthoracolumbarspinaldislocation

20ppt課件DiagnosisIntraoperativeRecognition

ImagingStudies

ExcretoryUrographyComputedTomographyRetrogradeUreterographyAntegradeUreterography21ppt課件Treatment22ppt課件Treatment23ppt課件BladderTraumaThemostcommonassociatedinjuryispelvicfracture,associatedwith83%to95%ofbladderinjuries

obstetricandgynecologiccomplicationsarethemostcommonetiologyofIatrogenicbladderinjuries

24ppt課件diagnosis恥骨上區(qū)疼痛或觸痛不能排尿或尿量減少尿中有血塊CT或超聲提示腹腔內(nèi)游離液體會陰或生殖器外傷體征無反應(yīng)、醉酒或感知異常腹部膨脹或腸梗阻25ppt課件RadiographicImaging26ppt課件TreatmentTheusualtreatmentofuncomplicatedextraperitonealbladderruptures,whenconditionsareideal,isconservativemanagementwithurethralcatheterdrainagealone

complicationssuchasfistula,abscess,andprolongedleak

27ppt課件28ppt課件INDICATIONSFORIMMEDIATEREPAIROFBLADDERINJURY外傷導(dǎo)致的腹腔內(nèi)損傷穿刺傷或醫(yī)源性非泌尿外科損傷膀胱引流不暢或尿中有血塊膀胱頸損傷直腸或子宮損傷開放性骨盆骨折骨盆骨折需要復(fù)位和內(nèi)固定由于其他原因行剖腹探查的穩(wěn)定患者骨碎片插入膀胱內(nèi)29ppt課件UrethralTraumaPosteriorUrethra

AnteriorUrethra

30ppt課件PosteriorUrethraStraddlefractures”involvingallfourpubicrami

openfractures,andfracturesresultinginbothverticalandrotationalpelvicinstabilityareassociatedwiththehighestriskofurologicinjury

31ppt課件diagnosisUrethraldisruptionisheraldedbythetriadofbloodatthemeatus,inabilitytourinate,andpalpablyfullbladder

urethralcathetercannotbeplaced;misplacedintopelvichematoma.impalpableprostateUrethrography

32ppt課件TreatmentSuprapubicCystostomy

PrimaryRealignment

DelayedReconstruction:At3months,scartissueattheurethraldisruptionsiteisstableenoughtoallowposteriorurethroplastytobeundertakensafely,providedthatassociatedinjuriesarestabilizedandthepatientisambulatory33ppt課件PrimaryRealignment34ppt課件DelayedReconstruction35ppt課件Transurethralcutting-to-the-lightprocedure36ppt課件AnteriorUrethraThemajorityoccurafterstraddleinjuryandinvolvethebulbarurethraIn20%ofthecasesofruptureofcorporacavernosa,theurethraisinvolved37ppt課件38ppt課件InjuriesofthegenitaliaPenis(Fracture,GunshotsandPenet