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重症腎外傷(粉砕腎・腎茎部損傷)の2症例に対して緊急腎摘出術を行った。後腹膜血腫,腸管浮腫,止血のためのパッキングにより閉腹できなかった。無理に閉腹すれば腹腔内圧が上昇し,呼吸器,循環器,腎臓へ障害を生じる腹部コンパートメント症候群を発症する危険性が高かった。ダメージコントロール手術(damage control surgery:DC)であるsilo closureにて救命できた。
An emergency nephrectomy was performed in 2 cases of severe renal injury(renal fragmentation and renal pedicle injury). Primary abdominal closure was judged to be in appropriate because of the presence of a retroperitoneal hematoma and intestinal edema and the use of packing to achieve hemostasis. If the abdomen were nonetheless closed,intra-abdominal pressure would have increased and there would be a considerable risk of abdominal compartment syndrome,producing respiratory,circulatory,and kidney impairment. Silo closure,a means of damage control surgery by which surgery is completed without primary abdominal closure was able to prevent death.
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