McAninch J W, Carroll P R, Klosterman P W, Dixon C M, Greenblatt M N
Department of Urology, University of California School of Medicine, San Francisco 94143-0738.
J Urol. 1991 May;145(5):932-7. doi: 10.1016/s0022-5347(17)38494-x.
During an 11-year period 1,363 patients presented to our institution with renal trauma. Renal exploration was performed in 127 patients (133 renal units). Most patients had multiple organ injuries, as indicated by a mean blood loss of 4,160 ml. and a mean injury severity score of 25.8. Absolute indications for exploration were bleeding and pulsatile perirenal hematoma and relative indications included urinary extravasation, nonviable renal tissue and incomplete staging. Renal surgery was required in 2.4% of the blunt injuries, 45% of the stab wounds and 76% of the gunshot wounds. Salvage was successful in 88.7% of the kidneys explored and total nephrectomy was required in 11.3%. The success rate was based on early vascular control and reconstructive techniques of "renorrhaphy," partial nephrectomy, vascular repair and coverage with omental pedicle flaps. Complications occurred in 9.9% of the cases but none resulted in renal loss. When indicated, renal exploration after trauma is safe and in a high percentage of cases reconstruction will be successful.
在11年期间，1363例肾外伤患者前来我院就诊。127例患者（133个肾单位）接受了肾探查。大多数患者有多处器官损伤，平均失血量为4160毫升，平均损伤严重度评分为25.8。探查的绝对指征是出血和肾周搏动性血肿，相对指征包括尿外渗、无活力的肾组织和分期不完整。钝性损伤患者中2.4%、刺伤患者中45%、枪伤患者中76%需要进行肾脏手术。88.7%接受探查的肾脏挽救成功，11.3%需要行全肾切除术。成功率基于早期血管控制和“肾缝合术”、部分肾切除术、血管修复以及带蒂大网膜瓣覆盖等重建技术。9.9%的病例发生了并发症，但无一例导致肾脏丧失。如有指征，外伤后进行肾探查是安全的且在高比例病例中重建将会成功。
