损伤控制与肾损伤的治疗

Damage control and the management of renal injury

肾损伤时,由于其周围组织的保护作用,使它不同于腹腔内其他实质器官,对于一般性的出血具有较强的自限性,故目前对于肾损伤多倾向于保守治疗。但对于较严重的肾损伤,尤其是保守治疗无效时,手术探察往往导致较高的肾切除率。而施行损伤控制性手术,简单快速地控制出血与污染,则能最大限度地保存有功能的肾组织。在重度肾损伤的救治中,损伤控制外科已越来越显示出其优越性。

When injured, kidney is different from other parenehymal organs in the abdomen in that it can be protected by perirenal tissues, and renal bleeding is generally self-limited if not too violent. Therefore, kidney injuries tend to be managed by nonsurgical therapies. If the renal injury is too severe to respond to conservative treatment, operative exploration becomes necessary, which unfortunately often leads to a high rate of nephrectomy. However, damage control surgery can maximally preserve the functional renal tissues and rapidly control bleeding and contamination, and is therefore becoming more and more preferable in the management of severe kidney injuries.