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上下泌尿生殖道贯穿伤的初始评估与处理

Author
Michael S Runyon, MD, MPH
Section Editor
Maria E Moreira, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM
Translators
孙卫兵, 主任医师，教授

引言

泌尿生殖系统(genitourinary, GU)贯穿伤的及时诊断和处理可使相关的并发症减到最少，并发症可包括肾功能不全、尿失禁以及性功能障碍。迅速的损伤鉴别依赖于考虑到以下几点的系统评估：损伤机制、相关体格检查的发现、尿液分析，以及按照正确顺序进行的合适诊断性影像学检查。

理想情况下，对于稳定的患者，GU损伤的检查由外生殖器评估开始，逆向进行。在下泌尿生殖道(膀胱和尿道)损伤排除后，或在开始对已鉴别的下泌尿生殖道损伤进行紧急处理后再进行上泌尿生殖道(输尿管和肾)的评估。

除罕见情况(如肾粉碎伤或肾脏大血管撕裂)外，GU损伤鲜有危及生命的情况出现。就这一点而论，对于复合损伤或不稳定的患者，GU损伤的评估应推迟，直至排除其他潜在威胁生命的损伤且患者稳定。

上、下泌尿生殖道贯穿伤的评估及初始处理总结在此。GU钝伤(包括骑跨伤)以及创伤处理的其他方面将单独讨论。 (参见“泌尿生殖系统钝挫伤：初步评估和治疗”和“儿童骑跨伤的评估和处理”)

流行病学

大约10%的创伤患者伴GU损伤。这些患者中约15%是贯穿伤，最常见于枪击或者刺伤[1]。除肾碎裂伤或肾脏大血管撕裂可出现大出血外，GU贯穿伤很少危及生命。

                    

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Literature review current through: 2017-06 . | This topic last updated: 2015-10-09.
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