Department of Surgery, Waikato Hospital, New Zealand.
Department of Surgery, Auckland City Hospital, New Zealand and Department of Surgery, University of the Witwatersrand, South Africa and Department of Surgery, University of KwaZulu-Natal, South Africa.
S Afr J Surg. 2023 Mar;61(1):56-60.
This paper reviews our experience with management of renal injuries in children and adolescents with a focus on the outcome of non-operative management (NOM).
Retrospective review of the clinical characteristics, injury grade (I-III, low grade and IV and V high grade), management and outcomes of children ≤ 18 years old with renal trauma presenting to a major trauma centre in South Africa between December 2012 and October 2020.
Sixty-one children with a renal injury were identified with a median age of 13 (range 0-18) years. Forty-five were boys; blunt and penetrating mechanisms of trauma were sustained by 55 (90%) and six (10%) children, respectively. The median American Association for the Surgery of Trauma (AAST) grade of renal injury was 3 (range 1-5): this included eight (13%) with grade I, six (10%) with grade II, 17 (28%) with grade III, 20 (46%) with grade IV and 10 (16%) with grade V injuries. Forty children (66%) were successfully managed non-operatively and 21 required a laparotomy; of these six (28%) required nephrectomy. The overall renal salvage rate was 55/61 (90%). Children who required laparotomy were significantly more likely to have sustained a penetrating mechanism of injury (24% vs 2%) and have greater length of hospital stay (median 9 vs 3 days) compared to children managed non-operatively ( < 0.05). Children who underwent a nephrectomy had a significantly greater length of hospital stay (median 9 vs 4 days, = 0.03); however, their demographics, outcomes developed complications. Two children (3%) died; one managed non-operatively and one with a laparotomy.
Paediatric renal trauma can be successfully managed non-operatively in over two-thirds of cases in this middle-income country. High grade of renal injury does not absolutely predict need for surgery or nephrectomy and can be managed non-operatively.
本文回顾了我们在儿童和青少年肾损伤管理方面的经验，重点介绍了非手术治疗（NOM）的结果。
对 2012 年 12 月至 2020 年 10 月期间在南非一家主要创伤中心就诊的≤18 岁儿童肾外伤患者的临床特征、损伤分级（I-III 级，低级别和 IV 和 V 级，高级别）、治疗方法和结局进行回顾性分析。
共确定 61 例肾损伤患儿，中位年龄 13 岁（范围 0-18 岁）。45 例为男性；55 例（90%）和 6 例（10%）患儿分别遭受钝性和穿透性创伤机制。美国外科医师协会（AAST）肾损伤分级的中位数为 3 级（范围 1-5 级）：包括 8 例（13%）I 级、6 例（10%）II 级、17 例（28%）III 级、20 例（46%）IV 级和 10 例（16%）V 级损伤。40 例（66%）患儿成功接受非手术治疗，21 例需要剖腹手术；其中 6 例（28%）需要肾切除术。整体肾保留率为 55/61（90%）。需要剖腹手术的患儿更有可能遭受穿透性损伤机制（24%比 2%），且住院时间更长（中位数 9 天比 3 天），与接受非手术治疗的患儿相比差异有统计学意义（<0.05）。接受肾切除术的患儿住院时间明显更长（中位数 9 天比 4 天，=0.03）；然而，他们的人口统计学特征、结局及并发症发展情况相似。2 例患儿（3%）死亡；1 例接受非手术治疗，1 例接受剖腹手术。
在这个中等收入国家，超过三分之二的儿童肾外伤可以成功地接受非手术治疗。高级别肾损伤并不绝对预示着需要手术或肾切除术，且可以进行非手术治疗。
