儿童肾外伤的管理：系统回顾和Meta分析

Management of Renal Trauma in Children: A Systematic Review and Meta-Analysis

摘要: 目的：肾脏损伤在儿童泌尿系统损伤中最为常见，大多数关于肾外伤的文献是基于成人病例系列和回顾性资料。本文就儿童肾外伤管理的文献进行系统回顾和meta分析。方法：根据PRISMA指南，检索PubMed、Embase、Web of Science、中国知网、万方、维普等数据库，搜索中文关键词为“儿童”或“小儿”、“肾外伤”或“肾挫裂伤”或“肾损伤”及英文关键词“blunt renal trauma”or“Renal Trauma”or“Kidney Trauma”or“Renal Injury”、“Pediatric”or“Children”，检索的最后日期是2023年5月。采用纽卡斯尔–渥太华量表(NOS)对纳入文献进行质量评价，使用RevMan5.3软件进行Meta分析。结果：共纳入38篇文献，总病例数为1666例，文献的NOS评分为5~9分；其中36篇文献报道了性别，男女比例约为7:3，平均年龄为10.11岁；在28项报道受伤机制的文献中，我们发现以交通事故及高处坠落伤最多见。将高级别(IV~V级)肾损伤的369例患者分为手术组和非手术组，手术组的肾丢失率为32.95%，而非手术组肾丢失率为0.88%；将符合条件的25篇文献进行手术干预及非手术干预对儿童高级别肾损伤肾丢失率影响的Meta分析，采用固定效应模型分析得出非手术治疗与降低肾丢失率密切相关。结论：基于现有数据，非手术治疗已成为儿童肾外伤治疗的首选方案，可降低肾丢失率、减少医源性肾脏损失。但由于纳入研究的部分质量不高，仍需采用大样本、设计严谨、符合国际规范的实验方案提高证据质量。

Abstract: Purpose: Renal injuries are the most common of urinary tract injuries in children, and most of the literature on renal trauma is based on adult case series and retrospective data. This article provides a systematic review and meta-analysis of the literature on the management of renal trauma in chil-dren. Methods: According to the PRISMA guidelines, PubMed, Embase, Web of Science, China Knowledge, Wanfang, Wipo and other databases were searched, and the Chinese keywords “chil-dren” or “pediatric”, “renal trauma” or “renal contusion” or “renal injury”, and the English keywords “blunt renal trauma” or “Renal Trauma” or “Kidney Trauma” or “Renal Injury”, “Pediatric” or “Chil-dren”, were searched, with a last date of May 2023 for the search. Articles that did not involve hu-man patients, medically induced injuries, adult patients, cancer-related articles, review articles, surveys and case reports were not included in this search. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the included literature, and Meta-analysis was performed using RevMan 5.3 software. Results: A total of 38 papers were included, with a total number of 1666 cas-es, and the NOS scores of the papers ranged from 5 to 9; 36 of the papers reported gender, with a male-to-female ratio of about 7:3, and a mean age of 10.11 years; among the 28 papers that report-ed the mechanism of injury, we found that traffic accidents and fall-from-height injuries were the most common. The 369 patients with high-grade (grade IV-V) renal injuries were divided into sur-gical and non-surgical groups; the rate of kidney loss in the surgical group was 32.95%, whereas the rate of kidney loss in the non-surgical group was 0.88%; 25 eligible studies were subjected to Me-ta-analysis of the effects of surgical and non-surgical interventions on the rate of renal loss in high-grade renal injuries in children, and analyzed by using a fixed-effects model, which concluded that non-surgical treatments were closely associated with a reduced fixed-effect modeling analysis concluded that non-surgical treatment was strongly associated with a reduction in the rate of renal loss. Conclusion: Based on the available data, non-surgical treatment has become the preferred op-tion for the management of renal trauma in children, reducing the rate of kidney loss and minimiz-ing medically induced kidney loss. However, due to the low level of some of the treatments included in the study, there is still a need to improve the quality of evidence by using experimental protocols with large samples, rigorous design, and compliance with international norms.