腎外傷における手術適応の検討 CLINICAL STUDY OF THE SURGICAL APPLICATION FOR RENAL TRAUMA

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Abstract

過去12年半にわたり経験した腎外傷 (皮下損傷) 122例を集計し, その即時手術の適応に関し検討を加えた. 外傷度分類は腎挫傷, 軽度腎裂傷, 高度腎裂傷, 腎断裂傷, 腎茎部損傷に分類した. これは術前の臨床症状と画像診断にて分類した群と, 術中の手術所見を合わせて分類した群とを比較すると約4分の1は誤謬を生じていた. 今後画像診断学の進歩により診断率は高まるものと期待している.<br>今回の臨床的検討より次のことが要約される. 腎挫傷は待期療法が選択される. 軽度腎裂傷も手術の必要はなく, 待期療法で観察することが望ましい. 高度腎裂傷の場合, 待期療法では腎感染が増悪し, 腎障害が進行し, 手術の時期を逸してしまうことがある. そのため, 即時手術が必要である. 腎断裂傷, 腎茎部損傷は待期的に観察せずに即時手術を行うべきである. 特に重要なことは, 高度腎裂傷との診断が得られたら, 即時手術を行うことである.

One hundred and twenty-two cases with renal (blunt) trauma were reviewed and analyzed in order to obtain the best clinical guideline in terms of conservative or operative treatment. The cases were classified as renal contusion, slight renal laceration, severe renal laceration, renal rupture and renal pedicle injury by the clinical findings and the image diagnosis. The preoperative classification and the postoperative one including the findings of the operation agreed with 30 of 41 cases (73.2%).<br>According to the present investigation, our current therapeutic policy has been summarized as follows. Renal contusion is managed expectantly. Slight renal laceration is also conservatively observed. However, operation should be taken into consideration in patients with severe renal laceration, because most cases after conservative treatment were obliged to undergo nephrectomy once in a while. The immediate surgery would be the best management for renal rupture as well as renal pedicle injury.<br>Of special emphasis is that surgical intervention should be employed in cases of sever renal laceration, after an accurate staging is obtained with the aid of image diagnosis.

Journal

  • The Japanese Journal of Urology

    The Japanese Journal of Urology 77(6), 1000-1005, 1986

    THE JAPANESE UROLOGICAL ASSOCIATION

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