Silo closureが有用であった重症腎外傷の2例

Two cases of severe renal injury where silo closure was effective

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.