Narrod J A, Moore E E, Posner M, Peterson N E
J Trauma. 1985 Sep;25(9):842-4.
Nephrectomy for trauma is done infrequently due to the success of renal sparing procedures. The purpose of this review was to quantitate the effect of nephrectomy on patient outcome. Over a 5-year period 55 of 783 patients had renal injuries confirmed at trauma laparotomy. Nephrectomy was performed in 14 (25%) of these patients. Thirteen patients had penetrating injuries (12 gunshot wounds, one stab wound) and one patient was the victim of blunt trauma. The average number of associated injuries was 3.6. Three patients exsanguinated intraoperatively. Renal failure (serum creatinine greater than 2.5 mg%) developed in four patients; three required hemodialysis. The average time of onset of renal dysfunction was 3 weeks, and in every case it was preceded by intra-abdominal sepsis. Two patients died, both from multiple organ failure, on postoperative day 25 and 26, respectively. In the seven patients free of renal failure, one patient developed sepsis and subsequently died. Of the eight surviving patients, all had adequate renal function as evidenced by an average blood urea nitrogen of 14 mg%, serum creatinine of 1.3 mg%, and a creatinine clearance of 77 ml/min. Renal failure following nephrectomy for trauma occurs late in the hospital course and is invariably preceded by sepsis. Nephrectomy is a marker of severe intra-abdominal injury, but in itself is not the major determinant of survival.
由于肾脏保留手术的成功，因创伤而行肾切除术的情况并不常见。本综述的目的是量化肾切除术对患者预后的影响。在5年期间，783例患者中有55例在创伤剖腹手术中被证实有肾损伤。其中14例（25%）患者接受了肾切除术。13例患者为穿透伤（12例枪伤，1例刺伤），1例患者为钝性创伤受害者。平均合并伤数量为3.6处。3例患者术中失血过多死亡。4例患者出现肾衰竭（血清肌酐大于2.5mg%）；3例需要血液透析。肾功能障碍的平均发病时间为3周，且每种情况下均先有腹腔内感染。2例患者死亡，均死于多器官功能衰竭，分别在术后第25天和第26天。在7例未发生肾衰竭的患者中，1例发生感染，随后死亡。在8例存活患者中，所有患者肾功能均正常，平均血尿素氮为14mg%，血清肌酐为1.3mg%，肌酐清除率为77ml/min。创伤后肾切除术后的肾衰竭发生在住院病程后期，且总是先有感染。肾切除术是严重腹腔内损伤的一个标志，但本身并非生存的主要决定因素。
