Aubert J, Grange P, Doré B
Service d'Urologie, Pavillon C. Guérin, CHU, Poitiers.
J Urol (Paris). 1987;93(8):455-61.
Based on the personal observation of two cases and a series of 40 patients reported in the literature, the specific problems related to injuries to horseshoe kidney are evoked. The first case involved crushing of the isthmus against the spine recognized at operation on the 5th day and suggested by urography, CT scan and arteriography data. Abstention from surgery in the second case was decided on initial urography and ultrasound findings and the rapid, spontaneously favorable course. A literature review failed to provide much original data related to the anatomical anomaly, too frequently detected during emergency surgery. The only particularity is related to rupture of isthmus which may damage upper excretory pathways; this explains the interest for the authors of pyelostomy in case of conservative surgery in this context. When surgery is indicated this should be reserved to severe forms and postponed. It is important to carry out arteriography in addition to urography and a CT scan because of the particularity of the vascularization of this type of kidney: the anterior transperitoneal approach appears to be the best adapted.
基于对两例病例的个人观察以及文献报道的40例患者系列情况，引发了与马蹄肾损伤相关的具体问题。第一例病例是在术后第5天手术中发现峡部挤压脊柱，尿路造影、CT扫描和动脉造影数据提示了这一情况。第二例病例根据初始尿路造影和超声检查结果以及迅速自发好转的病程，决定不进行手术。文献综述未能提供太多与这种在急诊手术中频繁检测到的解剖异常相关的原始数据。唯一的特殊之处与峡部破裂有关，峡部破裂可能损害上排泄途径；这解释了在此情况下保守手术时肾盂造口术对作者们的吸引力。当需要进行手术时，应仅针对严重病例并推迟手术。由于这种类型肾脏血管化的特殊性，除了尿路造影和CT扫描外，进行动脉造影很重要：经腹前路似乎是最合适的。
