评价儿童严重创伤性肾损伤的处理及长期肾功能。
Evaluation of the management of severe trauma kidney injury and long-term renal function in children.
机构信息
From the Department of Urology, Grenoble Teaching Hospital (C.O., D.P.), and Grenoble Teaching Hospital (Y.T., B.B., P-Y.R., Y.R., C.P.), La tronche, France.
出版信息
J Trauma Acute Care Surg. 2018 Jun;84(6):951-955. doi: 10.1097/TA.0000000000001854.
BACKGROUND
To evaluate the management and long-term renal function with DMSA scintigraphy in pediatric severe traumatic kidney injury grade IV and V at the trauma center of Grenoble Teaching Hospital.
METHODS
This is a single-center observational retrospective study between 2004 and 2014. All children younger than 15 years and managed at the Grenoble teaching Hospital for a severe trauma kidney injury grade IV or V were included. The trauma grade was radiologically diagnosed on arrival at hospital, using the classification of the American Association for Surgery of Trauma. The management followed the algorithm in effect in the establishment. The assessment of the renal function was performed by a DMSA scintigraphy after at least 6 months from the injury.
RESULTS
Twenty-one children were managed for a severe renal trauma (16 IV and 5 V). The diagnosis was initially made by an ultrasonography (eight cases) or a computed tomography scan (13 cases). A child with a severe renal trauma IV underwent nephrectomy on day 6 of the trauma. Eleven children needed a therapeutic procedure (three embolizations, four double J stents, one arterial stent, one peritoneal lavage for a splenic hemoperitoneum, four pleural drainages). A DMSA scintigraphy was performed in 15 patients to assess the function of the injured kidney: 11 of 16 severe renal trauma IV with an average of 39.4%, and 17% in 4 of 5 severe renal trauma V analyzed.
CONCLUSION
Among the 21 children managed for a severe kidney trauma injury IV or V, 11 required a therapeutic procedure, one of them a nephrectomy. The DMSA scintigraphy performed after at least 6 months from the trauma found an injured renal function at 39.4% in 11 of 16 severe renal trauma IV analyzed, and 17% in 4 of 5 severe renal trauma V analyzed, which confirms the currently conservative management.
LEVEL OF EVIDENCE
Type of study: original article, retrospective observational study, level IV.
背景
在格勒诺布尔教学医院的创伤中心，评估 DMSA 闪烁扫描术在小儿重度创伤性肾损伤 IV 级和 V 级中的管理和长期肾功能。
方法
这是一项 2004 年至 2014 年间的单中心观察性回顾性研究。所有年龄小于 15 岁并在格勒诺布尔教学医院接受治疗的重度创伤性肾损伤 IV 级或 V 级的儿童均被纳入研究。入院时通过放射学诊断创伤等级，使用美国外科创伤协会的分类。治疗遵循建立时的算法。在受伤后至少 6 个月进行 DMSA 闪烁扫描术评估肾功能。
结果
21 名儿童因严重肾外伤（16 例 IV 级和 5 例 V 级）接受治疗。最初通过超声检查（8 例）或计算机断层扫描（13 例）做出诊断。1 例重度肾外伤 IV 级儿童在创伤后第 6 天接受了肾切除术。11 名儿童需要治疗（3 例栓塞、4 例双 J 支架、1 例动脉支架、1 例脾血肿腹腔灌洗、4 例胸腔引流）。15 名患者进行了 DMSA 闪烁扫描术以评估受损肾脏的功能：16 例重度肾外伤 IV 级中的 11 例平均为 39.4%，5 例重度肾外伤 V 级中的 4 例为 17%。
结论
在因重度肾外伤 IV 或 V 接受治疗的 21 名儿童中，11 名需要治疗，其中 1 例需要肾切除术。在至少 6 个月后进行的 DMSA 闪烁扫描术发现，在 16 例重度肾外伤 IV 级中，11 例的肾功能受损，比例为 39.4%，在 5 例重度肾外伤 V 级中，4 例的肾功能受损，比例为 17%，这证实了目前的保守治疗方法。
证据水平
研究类型：原始文章，回顾性观察研究，IV 级。
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