摘要
目的探讨高级别闭合性肾损伤患儿肾动脉栓塞相对于手术探查在肾功能保护方面的优势及两者的疗效对比。方法回顾性分析2012年1月1日至2021年12月31日桂林地区两大三甲医院(广西壮族自治区南溪山医院、解放军第924医院)高级别闭合性肾损伤患儿的临床资料,并从中筛选出经保守治疗无效或血流动力学不稳定而接受了进一步干预的病例。经筛选,共44例满足条件,其中接受高选择性肾动脉栓塞的患儿共21例,为介入组(A组);急诊手术探查(依据术中情况行肾修补术、肾部分切除术或切除患肾)共23例,为探查组(B组)。比较A、B两组住院费用、住院天数、止血成功率等术后临床数据。出院后1年复查肾动态显像,比较两组患肾肾小球滤过率。结果住院天数、止血成功率两组间差异无统计学意义(P>0.05)。与B组相比,A组疼痛更轻(P<0.05)住院费用更低(P<0.05)输血量更少(P<0.05)患肾肾小球滤过率值更高(P<0.05)。结论在儿童高级别闭合性肾损伤的治疗中,对于单纯保守治疗无效需要进一步止血干预的病例,高选择性肾动脉栓塞与手术探查相比,止血效率相当,而高选择性肾动脉栓塞疼痛轻、输血量少、住院费用低,且有利于远期肾功能保护,应作为优先选择。
Objective To compare the renal function protection and curative effect between surgical exploration and renal artery embolization in pediatric with high-grade closed renal trauma.Methods The data of patients hospitalized for Grade Ⅲ-Ⅴ blunt renal trauma in Nanxishan Hospital of Guangxi and the 924th Hospital of PLA in Guilin from January 1,2012 to December 31,2021 was retrospectively analyzed.Patients who failed to respond to conservative treatment or were hemodynamic unstable and received further intervention were selected.A total of 44 cases were enrolled.21 patients were given highly selective renal artery embolization(RAE),named Group A.The other 23 cases received emergency surgical exploration,renal repair,partial nephrectomy or removal of the affected kidney,named Group B.The hospitalization expenses,days of hospitalization,glomerular filtration rate and other perioperative data were compared between A and B groups.Results There were no significant differences in the length of stay,and successful rate of hemostasis between the two groups(P>0.05).Compared with group B,group A had less pain(P<0.05),lower hospitalization costs(P<0.05),less blood transfusion(P<0.05),and higher glomerular filtration rate of affected kidney(P<0.05).Conclusions In the treatment of children with high-grade closed renal injury,compared with surgical exploration,highly selective renal artery embolization has the same hemostatic efficiency,less pain,less blood transfusion,lower hospitalization costs,and is beneficial to the protection of long-term renal function,so it should be priority to surgical exploration.
作者
朱良振
于永刚
陈杲
廖松柏
Zhu Liangzhen;Yiu Yonggang;Chen Gao;Liao Songbai(Department of Urology,Nanxishan Hospital of Guangxi Zhuang Autonomous Region,Guilin 541002,China;Department of Urology,The 924th Hospital of PLA,Guilin 541002,China)
出处
《中华腔镜泌尿外科杂志（电子版）》
2023年第5期461-465,475,共6页
Chinese Journal of Endourology(Electronic Edition)
基金
桂林市科学研究与技术开发项目(20220139-13-2)。
关键词
儿童
肾损伤
肾动脉栓塞
手术探查
Children
Renal trauma
Renal artery embolization
Surgical exploration
