Perirenal drainage

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. Surgery and treatment are required in the following situations: 1. Intravenous urography has obvious contrast of contrast agent or renal non-development or CT scan contrast agent spillover. 2. Patients with abdominal organ damage. 3. Renal angiography suggests that the renal artery is damaged or embolized. 4. During the non-surgical treatment, the kidney mass is increasing, the gross hematuria continues, and severe anemia occurs in the short term. 5. After anti-shock treatment, blood pressure can not rise or rise and fall again, suggesting that there is a major bleeding. For the surgical treatment of open kidney injury, the current opinion is that the cause of firearm injury is accompanied by chest or abdominal organ injury, and the incidence of infection is high, and surgery should be performed. For those who are stabbed by the anterior wall of the abdomen, they are often accompanied by abdominal organ injury and should be surgically explored. Non-surgical treatment can be observed under close observation if no obvious extravasation or collection system damage is found by back stab injury. Treatment of diseases: periarteritis Indication Peripheral drainage is suitable for: 1. In the case of wartime or equipment, lack of blood supply, severe kidney injury requires surgical treatment and can not perform more complicated surgery. 2. Isolated kidney and kidney damage or due to time constraints, unable to understand the contralateral kidney, must retain the injured kidney. 3. Kidney damage has extravasation of urine, hematoma, and failure to co-infect patients with early surgery. Preoperative preparation 1. Active anti-shock treatment, preparation of blood. 2. Indwelling catheter. Surgical procedure 1. Incision and exposure of the kidney The 12th rib incision was used to separate the layers and cut the perirenal fascia to reveal the kidney. The kidneys do not have to be completely free. 2. Remove dirt from the wound After cutting the perirenal fascia, the hematoma around the kidney, the extravasated urine and the contaminated necrotic tissue were removed. In the case of firearm injuries, the presence or absence of firearm fragments and free bone fragments in the ballistics should be carefully examined and removed. If there is active bleeding on the kidney wound, you can use 4-0 absorbable suture to stop bleeding, and you should try to repair the kidney laceration. If the kidney tissue is broken, can not be sutured and there is bleeding, you can use gelatin sponge to soak the thrombin on the wound surface, and then use a large vaseline gauze on the surface of the kidney. 3. Gauze packing The wound surface is filled with a long gauze strip against the surface of the Vaseline gauze to achieve the purpose of compression hemostasis and wound drainage. Note that the gauze strips to be packed should be folded from deep to shallow, and the tail end should be placed outside the slit so that it can be pulled out smoothly in the future. 4. Suture incision Sewing the layers of the incision in turn, taking care not to suture the end of the stuffed gauze too tightly to avoid difficulty in pulling out.

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