Göthlin J, Ingemansson S, Lindstedt E, Tranberg K G
Acta Chir Scand. 1976;142(2):165-71.
From 1861 to 1975 fifty-three cases of blunt renal pedicle injury have been reported. Sixty-five kidneys were involved (twelve bilateral injuries) and 32 of them were removed. Reconstructive surgery was tried on 17 kidneys, of which only one healed without complication and with recovery of normal function. In addition, in 4 patients with bilateral injury, operation preserved enough kidney function to save the patients from hemodialysis, though 2 of them developed hypertension. This paper reports 4 further cases. In 2 patients with renal artery thrombosis nephrectomy was eventually performed after preceding reconstructive or conservative treatment. The third patient with thrombosis was not seen until several years after the trauma and was treated conservatively. The fourth patient had a ruptured intrarenal arterial branch with massive hematuria and finally required resection of the kidney. An early diagnosis of renal artery injury following severe abdominal trauma requires immediate aortography, sometimes with subsequent selective catheterization. If renal trauma is not strongly suspected, intravenous large dose pyelography may be indicated as the first step. Surgical repair should consist of resection of the injured artery and reconstruction with a venous graft, or autotransplantation of the kidney. If treated conservatively, the patient must be followed up at regular intervals for hypertension and other complications.
从1861年至1975年，共报告了53例钝性肾蒂损伤病例。累及65个肾脏（12例双侧损伤），其中32个肾脏被切除。对17个肾脏尝试进行了重建手术，其中只有1个愈合良好，无并发症且肾功能恢复正常。此外，在4例双侧损伤患者中，手术保留了足够的肾功能，使患者无需进行血液透析，尽管其中2例出现了高血压。本文报告另外4例病例。2例肾动脉血栓形成患者在先行重建或保守治疗后最终进行了肾切除术。第3例血栓形成患者在创伤后数年才被发现，并接受了保守治疗。第4例患者肾内动脉分支破裂并出现大量血尿，最终需要切除肾脏。严重腹部创伤后肾动脉损伤的早期诊断需要立即进行主动脉造影，有时随后还需进行选择性插管。如果没有强烈怀疑肾创伤，静脉大剂量肾盂造影可作为第一步检查。手术修复应包括切除受损动脉并用静脉移植物进行重建，或进行肾脏自体移植。如果进行保守治疗，必须定期对患者进行随访，以监测高血压及其他并发症。
