Barsness Katherine A, Bensard Denis D, Partrick David, Hendrickson Richard, Koyle Martin, Calkins Casey M, Karrer Frederick
Division of Pediatric Surgery, Department of Surgery, The Children's Hospital, University of Colorado Health Sciences Center, Denver, Colorado, USA.
J Trauma. 2004 Aug;57(2):310-5. doi: 10.1097/01.ta.0000141329.74804.e2.
Renovascular injury is uncommon among children. This study hypothesized that preservation of the severely injured kidney can be achieved safely without renal insufficiency, postinjury hypertension, or the need for hemodialysis.
Retrospective chart review of renal injuries seen between 1997 and 2001 at a level 1 pediatric trauma center was conducted. Severity of injury was graded by the American Association for the Surgery of Trauma Organ Injury Severity Scale. The outcome variables included the need for hemodialysis, impaired renal function (creatinine), and postinjury hypertension.
In this study, 34 children presented with grade 1, 2, or 3 injury (74%), whereas 13 children presented with grade 4 or 5 renovascular injury (28%). The children with unilateral renovascular injury who underwent either nephrectomy or renal preservation had comparable outcomes with no hypertension, hemodialysis, or renal insufficiency in either group.
The treatment outcomes were not different between the patients who underwent renal preservation and those who had immediate nephrectomy. The authors conclude that renal preservation should be attempted for all children with grade 4 or 5 renovascular injury.
肾血管损伤在儿童中并不常见。本研究假设，对于严重受伤的肾脏，在不出现肾功能不全、伤后高血压或无需血液透析的情况下，能够安全地实现保留。
对1997年至2001年期间在一家一级儿童创伤中心所见的肾损伤进行回顾性病历审查。损伤严重程度根据美国创伤外科协会器官损伤严重程度评分量表进行分级。结果变量包括是否需要血液透析、肾功能受损（肌酐水平）以及伤后高血压。
在本研究中，34名儿童出现1级、2级或3级损伤（74%），而13名儿童出现4级或5级肾血管损伤（28%）。接受肾切除术或保留肾脏的单侧肾血管损伤儿童，两组的结局相当，均未出现高血压、血液透析或肾功能不全。
接受肾脏保留治疗的患者与立即接受肾切除术的患者的治疗结局并无差异。作者得出结论，对于所有4级或5级肾血管损伤的儿童，均应尝试保留肾脏。
