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手术修复严重肾损伤27例

徐华南 郑伟成 苑勇 李汉俊 褚光 汪少华

  【摘要】 目的 报告27例严重肾损伤的手术治疗体会,旨在降低伤肾切除率。方法 术中采用静脉注射肌苷后,常温下阻断肾血流,根据肾破裂情况,分别采用肾部分切除、分层对位缝合、血管修补等修复手术。伤肾热缺血最长102分钟,最短28分钟,平均53分钟。结果 25例修复成功,2例肾切除,手术失肾率为7.4%;25例在术后14天~9个月行IVU检查,伤(残)肾功能及形态良好;21例随访4个月~11年,血压、尿常规均正常。结论 本法可明显降低严重肾损伤的肾切除率。
  【关键词】 肾 损伤 肌苷 肾热缺血 手术

Surgical Treatment for 27 Patients with Severe Renal Trauma  XU Hua-nan, ZHENG Wei-cheng, YUAN Yong, et al. Dept. of Urology, First People s Hospital of Mengcheng, Anhui 233500
  【Abstract】 Aim To report the experience of operative treatment for severe renal trauma on 27 cases. Methods During the operation, the renal blood supply was blocked for 10 minutes after intravenous of 2g inosine in normothermia. According to the condition of renal trauma, partial nephrectomy, nephrorrhaphy, nephroangistomy were made. The longest time of warm ischemia of kidney was 102 minutes, the shortest time of that was 28 minutes, with the average of 53 minutes. Results The kidneys of 25 cases were repaired successfully, and two cases were done with nephrectomy (7.4%). 14 days to 9 months after operation, intravenous urography (IVU) showed the renal functions were normal on 25 cases with the kidneys repaired. 21 cases followed up for 4 months to 11 years, the blood pressure, the urine showed normal in all patients. Conclusion The incidence of nephrectomy in the cases with severe renal trauma can be reduced obviously with renal repairment.
  【Key words】  Kidney Injury Inosine Warm ischemia of kidney Operation

  自1985年3月以来,笔者采用修复手术治疗严重肾损伤,迄今治疗27例,报告如下。

资料与方法
  1.一般资料:本组27例,男19例,女8例;年龄3~54岁,平均28.5岁。25例闭合性损伤中,以交通事故伤最多,其次为建筑物倒塌,高处坠落,腰部直接暴力击伤等。2例为锐器贯通伤。左肾伤12例,右肾15例。其中肾极的粉碎伤、离断伤及肾体部全层破裂或断裂18例,7例肾实质多道裂伤或星状破裂,2例肾体部贯通伤。22例有肾盂或肾盏破裂或者断裂,3例肾包膜严重撕脱,2例伴有肾门分支血管的断裂,1例肾动脉主干严重挫伤,2例肾静脉撕裂0.6cm和2cm。按Carlton分类,均为严重肾损伤[1]。25例为正常肾损伤,2例系病肾破裂。其中1例左肾上极血管平滑肌脂肪瘤破裂,另1例为先天性肾盂输尿管连接处梗阻,积水肾破裂。3例对侧上尿路异常,其中1例肾输尿管均有结石,中度积水;1例先天性小肾脏;1例肾血管平滑肌脂肪瘤破裂者系孤肾损伤,对侧肾曾因同样肿瘤被切除。

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