Mingoli Andrea, La Torre Marco, Migliori Emanuele, Cirillo Bruno, Zambon Martina, Sapienza Paolo, Brachini Gioia
Emergency Department.
Department of Surgery P Valdoni, Policlinico Umberto I, Sapienza University, Rome, Italy.
Ther Clin Risk Manag. 2017 Aug 31;13:1127-1138. doi: 10.2147/TCRM.S139194. eCollection 2017.
Preservation of kidney and renal function is the goal of nonoperative management (NOM) of renal trauma (RT). The advantages of NOM for minor blunt RT have already been clearly described, but its value for major blunt and penetrating RT is still under debate. We present a systematic review and meta-analysis on NOM for RT, which was compared with the operative management (OM) with respect to mortality, morbidity, and length of hospital stay (LOS).
The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed for this study. A systematic search was performed on Embase, Medline, Cochrane, and PubMed for studies published up to December 2015, without language restrictions, which compared NOM versus OM for renal injuries.
Twenty nonrandomized retrospective cohort studies comprising 13,824 patients with blunt (2,998) or penetrating (10,826) RT were identified. When all RT were considered (American Association for the Surgery of Trauma grades 1-5), NOM was associated with lower mortality and morbidity rates compared to OM (8.3% vs 17.1%, odds ratio [OR] 0.471; 95% confidence interval [CI] 0.404-0.548; <0.001 and 2% vs 53.3%, OR 0.0484; 95% CI 0.0279-0.0839, <0.001). Likewise, NOM represented the gold standard treatment resulting in a lower mortality rate compared to OM even when only high-grade RT was considered (9.1% vs 17.9%, OR 0.332; 95% CI 0.155-0.708; =0.004), be they blunt (4.1% vs 8.1%, OR 0.275; 95% CI 0.0957-0.788; =0.016) or penetrating (9.1% vs 18.1%, OR 0.468; 95% CI 0.398-0.0552; <0.001).
Our meta-analysis demonstrated that NOM for RT is the treatment of choice not only for AAST grades 1 and 2, but also for higher grade blunt and penetrating RT.
保留肾脏及肾功能是肾外伤（RT）非手术治疗（NOM）的目标。NOM用于轻度钝性RT的优势已得到明确阐述，但其对于重度钝性和穿透性RT的价值仍存在争议。我们对RT的NOM进行了一项系统评价和荟萃分析，并在死亡率、发病率和住院时间（LOS）方面将其与手术治疗（OM）进行了比较。
本研究遵循系统评价和荟萃分析的首选报告项目声明。在Embase、Medline、Cochrane和PubMed上进行了系统检索，以查找截至2015年12月发表的研究，无语言限制，这些研究比较了肾损伤的NOM与OM。
确定了20项非随机回顾性队列研究，共纳入13824例钝性（2998例）或穿透性（10826例）RT患者。当考虑所有RT（美国创伤外科学会1 - 5级）时，与OM相比，NOM的死亡率和发病率较低（8.3%对17.1%，优势比[OR]0.471；95%置信区间[CI]0.404 - 0.548；<0.001和2%对53.3%，OR 0.0484；95% CI 0.0279 - 0.0839，<0.001）。同样，即使仅考虑高级别RT，NOM也是导致死亡率较低的金标准治疗方法（9.1%对17.9%，OR 0.332；95% CI 0.155 - 0.708；=0.004），无论是钝性（4.1%对8.1%，OR 0.275；95% CI 0.0957 - 0.788；=0.016）还是穿透性（9.1%对18.1%，OR 0.468；95% CI 0.398 - 0.0（此处疑似有误，可能是0.552）；<0.001）。
我们的荟萃分析表明，RT的NOM不仅是美国创伤外科学会1级和2级损伤的首选治疗方法，也是更高级别钝性和穿透性RT的首选治疗方法。
