利根中央病院における腎外傷症例の臨床的検討

• Published in: Journal of the Japanese Association for the Surgery of Trauma Vol. 30; no. 3; pp. 297 - 303
• Main Authors: 田村 芳美, 大木 亮, 冨田 健介, 大塚 保宏, 野村 昌史, 大木 一成
• Format: Journal Article
• Language: Japanese
• Published: 一般社団法人 日本外傷学会 2016; The Japanese Association for the Surgery of Trauma
• Subjects: renal trauma; snowboarding injury; transcatheter arterial-embolization; スノーボード外傷; 動脈塞栓術; 腎外傷
• ISSN: 1340-6264; 2188-0190
• DOI: 10.11382/jjast.30.297

(Objectives) We analyzed the clinical features of snowboarding-related renal injuries and the predictors of the necessity of adjuvant treatment (AT), such as transcatheter arterial embolization (TAE) or blood transfusions. (Methods) The cases of 87 renal trauma patients that were treated at our hospital between January 1992 and November 2015 were investigated by comparing the cases of patients that suffered snowboarding-related injuries (SB group) with those of patients whose injuries had other causes (NSB group). In the multivariate analysis, predictors of the necessity of AT were identified by performing comparisons between the patients that did (AT group) and did not (NAT group) require AT. (Results) Of the 30 cases in the SB group and 57 cases in the NSB group, 19 (63.3%) and 22 (38.6%) involved H2 hemorrhaging according to the H factor classification of hemorrhaging severity, respectively. Of the 9 cases involving falls induced by the opposite-edge phenomenon, H2 hemorrhaging was seen in 8 (88.9%). The renal trauma classification (p=0.0347), H factor (p=0.0484), and pre-traumatic renal lesions (p=0.0490) were identified as predictors of the necessity of AT. (Conclusions) Snowboarding-related renal injuries can be severe. Considering the predictors identified in this study, we must aim to improve the quality of conservative therapy by performing TAE aggressively. 　【目的】スノーボード腎外傷の臨床的特徴およびTAEまたは輸血といった補助的治療（以下AT）の必要性を予測する因子を解析することを目的とした．【方法】1992年１月より2015年10月まで当院で加療した腎損傷87症例を対象に，スノーボードによる症例をSB群，それ以外の原因による症例をNSB群とし比較検討した．一方，ATを施行した症例をAT群，未施行であった症例をNAT群とし，ATが必要な予測因子を多変量解析にて検討した．【結果】SB群30例，NSB群57例に対し，H2はそれぞれ19例（63.3％），22例（38.6％）であった．逆エッジ転倒は９例中８例（88.9％）がH2であった．ATが必要な予測因子は，腎損傷度分類（p＝0.0347）・H因子（p＝0.0484）・受傷前腎病変の有無（p＝0.0490）であった．【結語】スノーボードによる腎損傷は重症化することが多い傾向があることが示唆された．今回判明した予測因子を念頭にTAEを積極的に活用し保存的治療の質向上を目指すべきと思われた．