Angorn I B
Br J Surg. 1977 Jan;64(1):59-65. doi: 10.1002/bjs.1800640115.
Refractory renal haemorrhage following low velocity penetrating trauma has conventionally been treated by nephrectomy or partial nephrectomy. Anatomical studies have demonstrated that the renal artery branches are end-arteries, each branch supplying a renal segment, with no collateral artery supply between segments. Life-threatening haemorrhage is arterial, and usually issues from a single segmental artery easily demonstrable by renal angiography. Fourteen patients had various segmental arteries ligated to control haemorrhage. Associated visceral injuries were present in 4 patients. Preoperative selective renal arteriography was possible in 13 patients and demonstrated the bleeding site in all cases. Segmental dearterialization produced haemostasis in 12 of the 14 patients. One patient required nephrectomy and one patient ligation of a second segmental artery to control bleeding. All the patients survived the operative procedure. Supine renin levels were normal on the fourteenth postoperative day and no patient developed hypertension during the follow-up period of 9-24 months. Segmental renal dearterialization by open operation is a simple and effective technique of controlling refractory renal haemorrhage with maximum preservation of renal parenchyma.
低速穿透性创伤后难治性肾出血传统上采用肾切除术或部分肾切除术治疗。解剖学研究表明，肾动脉分支为终末动脉，每个分支供应一个肾段，各肾段之间无侧支动脉供血。危及生命的出血为动脉性出血，通常来自单一的肾段动脉，通过肾血管造影很容易显示。14例患者结扎了不同的肾段动脉以控制出血。4例患者伴有内脏损伤。13例患者术前行选择性肾动脉造影，所有病例均显示了出血部位。14例患者中有12例通过肾段去动脉化实现了止血。1例患者需要行肾切除术，1例患者结扎了第二条肾段动脉以控制出血。所有患者均存活了手术过程。术后第14天仰卧位肾素水平正常，在9至24个月的随访期内无患者发生高血压。开放手术行肾段去动脉化是一种简单有效的控制难治性肾出血的技术，能最大程度地保留肾实质。
