Non-operative management has become increasingly popular in the treatment of renal trauma. While data are robust in blunt mechanisms, the role of non-operative management in penetrating trauma is less clear. Additionally, there is a paucity of data comparing gunshot and stab wounds. A retrospective review of patients admitted to a high-volume level 1 trauma center (Groote Schuur Hospital, Cape Town) with penetrating abdominal trauma was performed. Patients with renal injuries were identified and compared based on mechanism [gunshot (GSW) vs. stab] and management strategy (operative vs. non-operative). Primary outcomes of interest were mortality and failure of non-operative management. Secondary outcomes of interest were nephrectomy rates, Clavien-Dindo complication rate, hospital length of stay, and overall morbidity rate. A total of 150 patients with renal injuries were identified (82 GSW, 68 stab). Overall, 55.2% of patients required emergent/urgent laparotomy. GSWs were more likely to cause grade V injury and concurrent intra-abdominal injuries (p > 0.05). The success rate of non-operative management was 91.6% (89.9% GSW, 92.8% stab, p = 0.64). The absence of hematuria on point of care testing demonstrated a negative predictive value of 98.4% (95% CI 96.8–99.2%). All but 1 patient who failed non-operative management had associated intra-abdominal injuries requiring surgical intervention. Opening of Gerota’s fascia resulted in nephrectomy in 55.6% of cases. There were no statistically significant risk factors for failure of non-operative management identified on univariate logistic regression. NOM of penetrating renal injuries can be safely and effectively instituted in both gunshot and stab wounds with a very low number of patients progressing to laparotomy. Most patients fail NOM for associated injuries. During laparotomy, the opening of Gerota’s fascia may lead to increased risk of nephrectomy. Ongoing study with larger populations is required to develop effective predictive models of patients who will fail NOM.

中文翻译：

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穿透性肾损伤：非手术治疗和打开 Gerota 筋膜影响的观察性研究

非手术治疗在肾外伤的治疗中越来越受欢迎。虽然数据在钝性机制方面是可靠的，但非手术治疗在穿透性创伤中的作用尚不清楚。此外，缺乏比较枪伤和刺伤的数据。对入住高容量 1 级创伤中心（开普敦格鲁特舒尔医院）的腹部穿透性创伤患者进行了回顾性研究。根据机制 [枪击 (GSW) 与刺伤] 和管理策略（手术与非手术）识别和比较肾损伤患者。感兴趣的主要结果是死亡率和非手术治疗失败。次要结果是肾切除率、Clavien-Dindo 并发症发生率、住院时间和总体发病率。共确定了 150 名肾损伤患者（82 名 GSW，68 名刺伤）。总体而言，55.2% 的患者需要急诊/紧急剖腹手术。GSW 更可能导致 V 级损伤和并发腹内损伤（p > 0.05）。非手术治疗的成功率为 91.6%（89.9% GSW，92.8% 刺，p = 0.64）。护理点检测中没有血尿的阴性预测值为 98.4%（95% CI 96.8-99.2%）。除 1 例非手术治疗失败的患者外，所有患者均伴有需要手术干预的腹内损伤。Gerota 筋膜打开导致 55.6% 的病例进行肾切除术。在单变量逻辑回归中没有发现非手术治疗失败的统计学显着风险因素。可以在枪伤和刺伤中安全有效地进行穿透性肾损伤的 NOM，只有极少数患者会进行剖腹手术。大多数患者因相关损伤而未能通过 NOM。在剖腹手术期间，Gerota 筋膜的打开可能会导致肾切除术的风险增加。需要对更大人群进行持续研究，以开发 NOM 失败患者的有效预测模型。