Velmahos George C, Constantinou Constantinos, Gkiokas George
Department of Surgery, Division of Trauma and Critical Care, Los Angeles County and University of Southern California Medical Center, 1200 N. State Street, Los Angeles, California 90033, USA.
World J Surg. 2005 Nov;29(11):1472-5. doi: 10.1007/s00268-005-7874-1.
Renal failure is a feared complication following operations for severe trauma. Injuries to the kidney may be managed by nephrectomy or nephrorrhaphy. Nephrectomy may increase the risk of renal failure in already at-risk trauma patients. Nephrectomy for trauma should be avoided to the extent possible because it is associated with renal failure. From a prospectively collected trauma database, 59 patients with nephrectomy were matched at 1:1 ratio with 59 patients with nephrorrhaphy. Matching criteria were age (+/- 5 years), Injury Severity Score (+/- 3), abdominal Abbreviated Injury Score (+/- 1), and mechanism of injury (blunt or penetrating). The rates of renal function compromise (defined as a serum creatinine level >2 mg/dl for more than 2 days) and renal replacement therapy (continuous or intermittent) were compared in the two groups. The two groups were well-matched and similar with regard to injury severity and organs injured. Between nephrectomy and nephrorrhaphy patients, there were no differences in renal function compromise (10% vs. 14%, p = 0.57), renal replacement therapy (5% vs. 0%, p = 0.12), length of hospital stay (19 +/- 26 vs. 20 +/- 21, p = 0.8), and mortality (15% vs. 12%, p = 0.59). Salvaging the injured kidney does not seem to offer an obvious clinical benefit regarding postoperative renal function. Given the increased operative complexity of nephrorrhaphy in comparison to nephrectomy and the frequent need to abbreviate the operation in patients with severe trauma, nephrectomy should not be avoided when appropriate.
肾衰竭是严重创伤手术后令人担忧的并发症。肾脏损伤可通过肾切除术或肾修补术进行处理。肾切除术可能会增加已有肾功能衰竭风险的创伤患者发生肾衰竭的风险。对于创伤患者，应尽可能避免进行肾切除术，因为其与肾衰竭相关。从一个前瞻性收集的创伤数据库中，选取了59例行肾切除术的患者，按1:1的比例与59例行肾修补术的患者进行匹配。匹配标准为年龄（±5岁）、损伤严重度评分（±3）、腹部简明损伤评分（±1）以及损伤机制（钝性或穿透性）。比较两组患者肾功能损害（定义为血清肌酐水平>2mg/dl持续超过2天）和肾脏替代治疗（持续或间歇性）的发生率。两组在损伤严重程度和受伤器官方面匹配良好且相似。在肾切除术和肾修补术患者之间，肾功能损害（10%对14%，p = 0.57）、肾脏替代治疗（5%对0%，p = 0.12）、住院时间（19±26天对20±21天，p = 0.8）以及死亡率（15%对12%，p = 0.59）方面均无差异。就术后肾功能而言，挽救受损肾脏似乎并未带来明显的临床益处。鉴于与肾切除术相比，肾修补术的手术复杂性增加，且严重创伤患者经常需要缩短手术时间，在适当情况下不应避免进行肾切除术。
