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Master Thesis

Traumatismes fermés du rein : épidémiologie, traitement conservateur et prise en charge du saignement : à propos de 500 cas entre 2010 et 2019 dans un trauma center de niveau 1

Abstract : Introduction: Traumatic kidney injuries are the most frequent among urogenital injuries. The management used to be surgical witch nephrectomy, it has become conservative since the early 2000s with the development of medical imaging, interventional radiology and trauma center organization. Our retrospective series studied epidemiological data and predictive factors of arterial embolization in a level 1 trauma center. Methods: We carried out a single-center retrospective study, including all patients admitted between january 2010 and december 2019 with a kidney injury. There were 500 patients with a kidney trauma, including 307 grades III, IV and V. The inclusion criteria was a grade III, IV or V trauma. Traumas after surgery, after biopsy or after extracorporeal shock wave lithotripsy were excluded. Our primary outcome for univariate analysis was the use of arterial embolization in renal trauma. We adjusted for multivariate analysis with statistically significant factors in univariate analysis. Results: The mean age was 33 years (SD: 18y/o). Management was conservative for 293/307 (95.5%) of grade III, IV and V traumas. Interventional radiology management was performed in 55 (18%) patients, including 23 (16%) grades III, 26 (18%) grades IV and 6 (26%) grades V. There were 44 (80%) selective embolizations, allowing renal preservation in 41 cases (93%). There were 5 (9%) proximal embolizations followed in 3 cases (60%) by nephrectomy afterwards. Finally, 6 patients had an arteriography without embolization. In total, 49/55 (89%) patients treated in interventional radiology were treated conservatively. The nephrectomy rate was 14/307 (4.5%) including 2/141 (1.4%) for grades III, 9/143 (6.3%) for grades IV and 3/23 (13%) for grades V. In univariate analysis, the factors significantly associated with the use of embolization were, hematoma rim distance (p <0.001), hemoglobin (p = 0.031), surgical procedure (p = 0.039) and hematuria (p = 0.032). Predictors of arterial embolization significant on multivariate analysis were hematoma rim distance (p <0.01) and trauma grade V (p = 0.031). Conclusion: Management was conservative for 293/307 trauma (95.5%). The rate of nephrectomy has decreased since 2014, from 10/144 (6.9%) to 4/163 (2.5%) after 2014. Arterial embolization was selective for 41 patients (80%), the rate of renal conservation after embolization management was 49/55 (89%). The structuring of a "trauma center" associated with the development of interventional radiology and standardization of the management of abdominal trauma have enabled the extension of a conservative strategy in, the management of renal trauma. These results allowed us to establish a diagnostic tree allowing a calculation of arterial embolization probability according to the initial characteristics of trauma. A project in the continuity of our study would be to validate these results prospectively.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03394851
Contributor : Jean-Hugues Morneau Connect in order to contact the contributor
Submitted on : Friday, October 22, 2021 - 11:27:01 AM
Last modification on : Sunday, October 24, 2021 - 3:31:08 AM

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  • HAL Id : dumas-03394851, version 1

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Sylvain Vienot. Traumatismes fermés du rein : épidémiologie, traitement conservateur et prise en charge du saignement : à propos de 500 cas entre 2010 et 2019 dans un trauma center de niveau 1. Médecine humaine et pathologie. 2021. ⟨dumas-03394851⟩

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