Renal laceration repair

Kidney damage is divided into two types: open and closed. Open injuries account for about 15% to 20%, and are more common in wartime. Closed injuries are most common in traffic accidents and industrial accidents. Kidney injury can be complicated by trauma to the chest and abdomen organs and other parts, especially open injuries. At the same time, attention should be paid to the diagnosis and treatment of combined injuries. There is currently no consensus on the classification of kidney damage. According to the pathology of the injury, it is divided into contusion, laceration, crushing injury, and kidney pedicle injury. There are also those who are classified into minor renal injuries and major renal injuries according to the degree of injury. Small renal injuries include renal contusion, superficial laceration of the renal cortex and small subhepatic hematoma, which account for about 85% to 90% of the total renal injury, and are generally treated with non-surgical treatment. Large renal injuries include deep renal laceration, renal rupture, renal fragmentation, and renal pedicle injury, which require urgent surgical treatment. History of trauma and hematuria are the basic basis for diagnosing kidney damage. A person with a lump in the waist often shows severe kidney damage and often requires surgery. In order to determine the degree of kidney damage and determine whether emergency surgery, under the conditions of the condition, abdominal plain film, intravenous urography, B-ultrasound and CT examination should be performed. If necessary, abdominal aorta-kidney angiography can be performed to determine the injury. Side and contralateral kidney conditions. Treatment of diseases: kidney damage Indication Kidney laceration repair is applicable to: In the surgical exploration, if the main laceration of the injured kidney is found to be neat, the other cracks are shallow, and the blood circulation of the whole kidney is good, and the renal laceration repair is feasible. Preoperative preparation 1. Active anti-shock treatment, preparation of blood 600 ~ 900ml, for intraoperative use. 2. Indwelling catheter. Surgical procedure 1. Selection of incisions If there is a possibility of a combined abdominal organ injury, a transabdominal intraperitoneal incision should be used to explore the abdominal cavity and treat it accordingly. If there is no other organ damage before surgery and the contralateral kidney is normal, the eleventh intercostal incision or the inferior margin of the 12 ribs is used to reveal the kidney. 2. Stop the injury of kidney and clear the perihematomal hematoma After cutting the renal fat sac, immediately remove the large blood clot around the kidney, and in the direction of the hematoma, use the left hand to probe the injured kidney, pinch it, and temporarily control the bleeding at the laceration. Then the blood is further removed and the entire kidney is released until the kidney pedicle. The kidneys and veins were clamped with a non-invasive blood vessel clamp or a heart ear clamp to control bleeding. 3. Repair pyelonephritis and laceration After controlling the bleeding, the renal fat sac is further dissociated, revealing the laceration site and carefully examining the depth of the laceration. The obvious bleeding point in the renal parenchymal laceration was sutured with a fine needle No. 0 silk suture. If the laceration is deep to the renal pelvis and renal pelvis, the mucosal layer of the rupture should be interrupted or sutured continuously with a 3-0 or 4-0 absorbable line. 4. suture the kidney The cleft of the renal parenchyma is sutured with a 2-0 absorbable suture, and a small muscle block or fat mass is placed under the cord to prevent the kidney parenchyma from being cleft when knotted. The renal capsule was sutured intermittently with a No. 0 silk thread. 5. Close the incision and place the drainage strip After the repair of the renal laceration, release the blood vessel clamp and observe whether the wound has a large amount of bleeding. Generally, the bleeding can be stopped by using hot saline gauze to stop bleeding for a few minutes. The wound is washed and the two layers of the perirenal fascia are sutured under the kidney to fix the kidney. 1 to 2 strips of rubber tube were placed around the kidney, and the incision was sutured layer by layer. complication The main complications after renal laceration repair are secondary hemorrhage, urinary fistula and pyelonephritis. Sometimes renal hypertension can occur due to renal ischemia, and blood pressure and urine routine should be checked regularly after surgery. An intravenous urography was performed 3 months after surgery to observe the function and morphology of the kidney.

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