TAE・SJカテーテル留置にて保存的治療に努めたが，腎全摘出術に至った腎損傷Ⅲb型の１例
20歳の男性．バイク走行中に転倒，電柱に激突し救急搬送された．左側腹部に打撲痕・圧痛を認め，初期評価で心拍数：136/分・血圧：66/34mmHgであり，FASTで脾周囲の液体貯留が確認された．２次評価で実施した造影CT検査で，左腎損傷Ⅲb型・動脈相で造影剤の漏出を認め，左腎損傷Ⅲb型・出血性ショックと診断，同日にTranscatheter Arterial Embolization（以下TAE）で止血した．受傷３日目に腹痛・貧血の進行があり再度動脈相で造影剤の漏出と尿漏を認めたため，TAE・Single Jカテーテル（以下SJ）留置を行った．経過良好であり同14日目にSJカテーテルを抜去した...
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| Published in | Journal of the Japanese Association for the Surgery of Trauma Vol. 29; no. 4; pp. 385 - 388 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本外傷学会
2015
The Japanese Association for the Surgery of Trauma |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1340-6264 2188-0190 |
| DOI | 10.11382/jjast.29.385 |
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| Abstract | 20歳の男性．バイク走行中に転倒，電柱に激突し救急搬送された．左側腹部に打撲痕・圧痛を認め，初期評価で心拍数：136/分・血圧：66/34mmHgであり，FASTで脾周囲の液体貯留が確認された．２次評価で実施した造影CT検査で，左腎損傷Ⅲb型・動脈相で造影剤の漏出を認め，左腎損傷Ⅲb型・出血性ショックと診断，同日にTranscatheter Arterial Embolization（以下TAE）で止血した．受傷３日目に腹痛・貧血の進行があり再度動脈相で造影剤の漏出と尿漏を認めたため，TAE・Single Jカテーテル（以下SJ）留置を行った．経過良好であり同14日目にSJカテーテルを抜去したが，同16日目の造影CT検査で尿漏を認め，同20日目に腹痛の増悪と尿漏の増悪を認めたことから保存的治療を断念し，同21日目に左腎全摘出術に至った． |
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| AbstractList | A 20-year-old male was admitted to our hospital with the complaint of left lateral abdominal pain following a motorcycle crash. He presented hemorrhagic shock. Contrast-enhanced CT (CE-CT) revealed severe renal trauma and extravasation of contrast medium. On the basis of a clinical diagnosis of hemorrhagic shock with severe renal trauma, we decided to treat the patient with the therapy of interventional radiology (IVR). Three days after the injury, his anemia and abdominal pain became worse, and CE-CT showed extravasation and renal trauma. We performed IVR and a single-J ureteral catheter was inserted. After the therapy, the patient was doing well, so the catheter was removed fourteen days after the injury. However, sixteen days after the injury, CE-CT showed extravasation and renal trauma again, and twenty days after the injury, the patient complained of abdominal pain and CE-CT showed that the renal trauma had worsened. We gave up on the conservative treatment and, twenty-one days after the injury, we undertook an operation to remove his left kidney.
20歳の男性．バイク走行中に転倒，電柱に激突し救急搬送された．左側腹部に打撲痕・圧痛を認め，初期評価で心拍数：136/分・血圧：66/34mmHgであり，FASTで脾周囲の液体貯留が確認された．２次評価で実施した造影CT検査で，左腎損傷Ⅲb型・動脈相で造影剤の漏出を認め，左腎損傷Ⅲb型・出血性ショックと診断，同日にTranscatheter Arterial Embolization（以下TAE）で止血した．受傷３日目に腹痛・貧血の進行があり再度動脈相で造影剤の漏出と尿漏を認めたため，TAE・Single Jカテーテル（以下SJ）留置を行った．経過良好であり同14日目にSJカテーテルを抜去したが，同16日目の造影CT検査で尿漏を認め，同20日目に腹痛の増悪と尿漏の増悪を認めたことから保存的治療を断念し，同21日目に左腎全摘出術に至った． 20歳の男性．バイク走行中に転倒，電柱に激突し救急搬送された．左側腹部に打撲痕・圧痛を認め，初期評価で心拍数：136/分・血圧：66/34mmHgであり，FASTで脾周囲の液体貯留が確認された．２次評価で実施した造影CT検査で，左腎損傷Ⅲb型・動脈相で造影剤の漏出を認め，左腎損傷Ⅲb型・出血性ショックと診断，同日にTranscatheter Arterial Embolization（以下TAE）で止血した．受傷３日目に腹痛・貧血の進行があり再度動脈相で造影剤の漏出と尿漏を認めたため，TAE・Single Jカテーテル（以下SJ）留置を行った．経過良好であり同14日目にSJカテーテルを抜去したが，同16日目の造影CT検査で尿漏を認め，同20日目に腹痛の増悪と尿漏の増悪を認めたことから保存的治療を断念し，同21日目に左腎全摘出術に至った． |
| Author | 坂田, 寛之 山田, 太平 松田, 健一 中尾, 篤典 小谷, 穣治 岡本, 彩那 |
| Author_FL | KOTANI Joji OKAMOTO Ayana NAKAO Atsunori SAKATA Hiroyuki MATSUDA Kenichi YAMADA Taihei |
| Author_FL_xml | – sequence: 1 fullname: SAKATA Hiroyuki – sequence: 2 fullname: YAMADA Taihei – sequence: 3 fullname: OKAMOTO Ayana – sequence: 4 fullname: MATSUDA Kenichi – sequence: 5 fullname: NAKAO Atsunori – sequence: 6 fullname: KOTANI Joji |
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| References | 7) Coburn M : Genitourinary trauma. Trauma 7th ed. Mattox KL, Moore EE, Feliciano DV, eds. New York : McGraw Hill, 2013 : 669-708. 8) Matthews LA, Smith EM, Spirnak JP : Nonoperative treatment of major blunt renal lacerations with urinary extravasation. J Urol 1997 ; 157 : 2056-2058. 11) Moudouni SM, Patard JJ, Manunta A, et al : A conservative approach to major blunt renal lacerations with urinary extravasation and devitalized renal segments. BJU Int 2001 ; 87 : 290-294. 12) 大友康裕, 辺見弘, 益子邦弘, ほか : 腎損傷の手術適応に関する臨床的研究 とくに腎温存手術のための早期開腹適応について. 日外傷会誌 1997 ; 1 : 7-13. 9) Al-Qudah HS, Santucci RA : Complications of renal trauma. Urol Clin North Am 2006 ; 33 : 41-53. 1) Baverstock R, Simons R, McLoughlin M : Severe blunt renal trauma : a 7-year retrospective review from a provincial trauma centre. Can J Urol 2001 ; 8 : 1372-1376. 2) Coburn M : Genitourinary trauma. Trauma 6th ed. Feliciano DV, Mattox K, Moore E, eds. New York : McGraw-Hill, 2008 : 789-825. 6) 日本外傷学会外傷専門診療ガイドライン編集委員会編 : 外傷専門診療ガイドラインJETEC. 第１版. 日本外傷学会・日本救急医学会監修. 東京 : へるす出版, 2014 : 95-100. 5) Summertom DJ, Djakovic N, Kitrey ND, et al : Guidelines on Urological Trauma. European Association of Urology 2013 : 9-24. 3) Bent C, Iyngkaran T, Power N, et al : Urological injuries following trauma. Clin Radiol 2008 ; 63 : 1361-1371. 4) 日本外傷学会臓器損傷分類委員会 : 腎損傷分類2008 (日本外傷学会). 日外傷会誌 2008 ; 22 : 265. 10) Alsikafi NF, McAninch JW, Elliott SP, et al : Nonoperative management outcomes of isolated urinary extravasation following renal lacerations due to external trauma. J Urol 2006 ; 176 : 2494-2497. |
| References_xml | – reference: 2) Coburn M : Genitourinary trauma. Trauma 6th ed. Feliciano DV, Mattox K, Moore E, eds. New York : McGraw-Hill, 2008 : 789-825. – reference: 3) Bent C, Iyngkaran T, Power N, et al : Urological injuries following trauma. Clin Radiol 2008 ; 63 : 1361-1371. – reference: 11) Moudouni SM, Patard JJ, Manunta A, et al : A conservative approach to major blunt renal lacerations with urinary extravasation and devitalized renal segments. BJU Int 2001 ; 87 : 290-294. – reference: 6) 日本外傷学会外傷専門診療ガイドライン編集委員会編 : 外傷専門診療ガイドラインJETEC. 第１版. 日本外傷学会・日本救急医学会監修. 東京 : へるす出版, 2014 : 95-100. – reference: 7) Coburn M : Genitourinary trauma. Trauma 7th ed. Mattox KL, Moore EE, Feliciano DV, eds. New York : McGraw Hill, 2013 : 669-708. – reference: 8) Matthews LA, Smith EM, Spirnak JP : Nonoperative treatment of major blunt renal lacerations with urinary extravasation. J Urol 1997 ; 157 : 2056-2058. – reference: 12) 大友康裕, 辺見弘, 益子邦弘, ほか : 腎損傷の手術適応に関する臨床的研究 とくに腎温存手術のための早期開腹適応について. 日外傷会誌 1997 ; 1 : 7-13. – reference: 4) 日本外傷学会臓器損傷分類委員会 : 腎損傷分類2008 (日本外傷学会). 日外傷会誌 2008 ; 22 : 265. – reference: 9) Al-Qudah HS, Santucci RA : Complications of renal trauma. Urol Clin North Am 2006 ; 33 : 41-53. – reference: 5) Summertom DJ, Djakovic N, Kitrey ND, et al : Guidelines on Urological Trauma. European Association of Urology 2013 : 9-24. – reference: 1) Baverstock R, Simons R, McLoughlin M : Severe blunt renal trauma : a 7-year retrospective review from a provincial trauma centre. Can J Urol 2001 ; 8 : 1372-1376. – reference: 10) Alsikafi NF, McAninch JW, Elliott SP, et al : Nonoperative management outcomes of isolated urinary extravasation following renal lacerations due to external trauma. J Urol 2006 ; 176 : 2494-2497. |
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| Snippet | 20歳の男性．バイク走行中に転倒，電柱に激突し救急搬送された．左側腹部に打撲痕・圧痛を認め，初期評価で心拍数：136/分・血圧：66/34mmHgであり，FASTで脾周囲の液体貯... A 20-year-old male was admitted to our hospital with the complaint of left lateral abdominal pain following a motorcycle crash. He presented hemorrhagic shock.... |
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| SubjectTerms | conservative treatment interventional radiology severe blunt kidney injury インターベンショナル・ラジオロジー 保存的治療 鈍的腎損傷 |
| Title | TAE・SJカテーテル留置にて保存的治療に努めたが，腎全摘出術に至った腎損傷Ⅲb型の１例 |
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