Comparison of surgery and renal artery embolization for high-grade blunt renal trauma in pediatric

doi:10.3877/cma.j.issn.1674-3253.2023.05.007

Abstract

Abstract:

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.

Key words: Children, Renal trauma, Renal artery embolization, Surgical exploration

Liangzhen Zhu, Yonggang Yu, Gao Chen, Songbai Liao. Comparison of surgery and renal artery embolization for high-grade blunt renal trauma in pediatric[J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(05): 461-465,475.

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References 25

[1]	Fernández-Ibieta M. Renal Trauma in Pediatrics: A Current Review[J]. Urology, 2018, 113: 171-178.
[2]	Wong KY, Jeeneea R, Healey A, et al. Management of pediatric high-grade blunt renal trauma: a 10-year single-centre UK experience[J]. BJU Int, 2018, 121(6): 923-927.
[3]	Moore EE, Shackford SR, Pachter HL, et al. Organ injury scaling: spleen, liver, and kidney[J]. J Trauma, 1989, 29(12): 1664-1666.
[4]	Smith TA, Eastaway A, Hartt D, et al. Endovascular embolization in renal trauma: a narrative review[J]. Ann Transl Med, 2021, 9(14): 1198-1198.
[5]	Thirayan V, Kong VY, Elsabagh A, et al. High-grade renal trauma in children and adolescents can be successfully managed non-operatively[J]. S Afr J Surg, 2023, 61(1): 56-60.
[6]	Keihani S, Xu YZ, Angela P, et al. Contemporary management of high-grade renal trauma: results from the american association for the surgery of trauma genitourinary trauma study[J]. J Trauma Acute Care surg, 2018, 84(3): 418-425.
[7]	Loftus CJ, Hagedorn JC, Johnsen NV. Does routine repeat imaging for blunt high-grade renal trauma lead to unnecessary interventions? J Trauma Acute Care Surg[J]. 2021, 90(1): 143-147.
[8]	Redmond EJ, Darcie AK, Peter DM, et al. Contemporary management of pediatric high grade renal trauma: 10-year experience at a level 1 trauma centre[J]. J Pediatr Urol, 2020, 16(5): 656.e1-656.e5.
[9]	Eassa W, El-Ghar MA, Jednak R, et al. Nonoperative management of grade 5 renal injury in children: does it have a place? [J]. Eur Urol, 2010, 57(1): 154-163.
[10]	Liguori G, Rebez G, Larcher A, et al. The role of angioembolization in the management of blunt renal injuries: a systematic review[J]. BMC Urol, 2021, 21(1): 104.
[11]	Hakam N, Keihani S, Shaw NM, et al. Grade V renal trauma management: results from the multi-institutional genito-urinary trauma study[J]. World J Urol, 2023, 41(7): 1983-1989.
[12]	Deininger C, Freude T, Wichlas F, et al. On the black slope: analysis of the course of a blunt renal trauma collective in a winter sports region[J]. Eur J Trauma Emerg Surg, 2022, 48(3): 2125-2133.
[13]	Sarang B, Raykar N, Gadgil A, et al. Outcomes of Renal Trauma in Indian Urban Tertiary Healthcare Centres: A Multicentre Cohort Study[J]. World J Surg, 2021, 45(12): 3567-3574.
[14]	Sujenthiran A, Elshout PJ, Veskimae E, et al. Is nonoperative management the best first-line option for high-grade renal trauma? a systematic review[J]. Eur Urol Focus, 2019, 5(2): 290-300.
[15]	Kitrey ND, Campos-Juanatey F, Hallscheidt P, et al. EAU Guidelines on Urological Trauma[EB/OL].[2023-03-20]. URL
[16]	Marios H, Edmund G, Robert G, et al. Managing penetrating renal trauma: experience from two major trauma centres in the UK[J]. BJU international, 2018, 121(6): 928-934.
[17]	Hao X, Xu LM, Yu JL, et al. A comparative study of conservation, endovascular embolization therapy, and surgery for blunt renal trauma[J]. Med Sci Monit, 2020, 26: e922802.
[18]	Hakam N, Amend GM, Nabavizadeh B, et al. Utility and Outcome of Angioembolization for High-Grade Renal Trauma Management in a Large Hospital-Based Trauma Registry[J]. J Urol, 2022, 207(5): 1077-1085.
[19]	Aragona F, Pepe P, Patanè D. Management of severe blunt renal trauma in adult patients: a 10-year retrospective review from an emergency hospital[J]. BJU Int, 2012, 110(5): 744-748.
[20]	Chen J, Cai WC, Li LP. Profile of renal artery embolization (RAE) for renal trauma: A comparison of data from two major trauma center[J]. Int Braz J Urol, 2020, 46(2): 194-202.
[21]	Salem MS, Urry RJ, Kong VY, et al. Traumatic renal injury Five-year experience at a major trauma centre in South Africa[J]. Injury, 2020, 51(1): 39-44.
[22]	Sarang B, Raykar N, Gadgil A, et al. Outcomes of renal trauma in indian urban tertiary healthcare centres: a multicentre cohort study[J]. World J Surg, 2021, 45(12): 3567-3574.
[23]	Khoschnau S, Jabbour G, Al-Hassani A, et al. Traumatic kidney injury: An observational descriptive study[J]. Urol Int, 2020, 104:148-155.
[24]	Locke JA, Neu S, Navaratnam R, et al. Management of high-grade renal traumas with collecting system injuries[J]. Can Urol Assoc J, 2021, 15(11): E588-E592.
[25]	Keihani S, Rogers DM, Putbrese BE, et al. The american association for the surgery of trauma renal injury grading scale: implications of the 2018 revisions for injury reclassification and predicting bleeding interventions[J]. J Trauma Acute Care Surg, 2020, 88(3): 357-365.

组别	例数	性别(例)		年龄[岁，(±s)]	受伤原因(例)			Wong-Baker疼痛评分[M(Q)]	肉眼血尿(例)	血红蛋白<10 g/dL(例)	收缩压<90 mmHg(例)	心率>120次/min(例)	血肿大小[cm，(±s)]	入院肌酐[μmol/L，(±s)]
组别	例数	男	女	年龄[岁，(±s)]	交通事故	高处坠落	撞击	Wong-Baker疼痛评分[M(Q)]	肉眼血尿(例)	血红蛋白<10 g/dL(例)	收缩压<90 mmHg(例)	心率>120次/min(例)	血肿大小[cm，(±s)]	入院肌酐[μmol/L，(±s)]
A组	21	13	8	8±4	13	3	5	7(6，8)	19	8	4	17	5.1±1.0	76±17
B组	23	16	7	9±3	16	3	4	7(6，8)	20	8	5	22	4.9±0.9	70±21
统计值		χ²=0.287		t=0.076	χ²=0.331			Z=0.012	χ²=0.135	χ²=0.052	χ²=0.049	χ²=1.122	t=0.605	t=1.113
P值		0.592		0.500	0.847			0.991	0.713	0.820	0.825	0.290	0.548	0.272

组别	例数	性别(例)		年龄[岁，(±s)]	受伤原因(例)			Wong-Baker疼痛评分[M(Q)]	肉眼血尿(例)	血红蛋白<10 g/dL(例)	收缩压<90 mmHg(例)	心率>120次/min(例)	血肿大小[cm，(±s)]	入院肌酐[μmol/L，(±s)]
组别	例数	男	女	年龄[岁，(±s)]	交通事故	高处坠落	撞击	Wong-Baker疼痛评分[M(Q)]	肉眼血尿(例)	血红蛋白<10 g/dL(例)	收缩压<90 mmHg(例)	心率>120次/min(例)	血肿大小[cm，(±s)]	入院肌酐[μmol/L，(±s)]
A组	21	13	8	8±4	13	3	5	7(6，8)	19	8	4	17	5.1±1.0	76±17
B组	23	16	7	9±3	16	3	4	7(6，8)	20	8	5	22	4.9±0.9	70±21
统计值		χ²=0.287		t=0.076	χ²=0.331			Z=0.012	χ²=0.135	χ²=0.052	χ²=0.049	χ²=1.122	t=0.605	t=1.113
P值		0.592		0.500	0.847			0.991	0.713	0.820	0.825	0.290	0.548	0.272

	例数	Ⅳ、Ⅴ级构成比		止血成功率		合计成功率
	例数	Ⅳ	Ⅴ	Ⅳ	Ⅴ	合计成功率
A组	21	17	4	16/17	3/4	19/21
B组	23	18	5	18/18	4/5	22/23
χ²值		0.049		1.475	0.032	0.007
P值		1.000		0.224	0.858	0.935

	例数	Ⅳ、Ⅴ级构成比		止血成功率		合计成功率
	例数	Ⅳ	Ⅴ	Ⅳ	Ⅴ	合计成功率
A组	21	17	4	16/17	3/4	19/21
B组	23	18	5	18/18	4/5	22/23
χ²值		0.049		1.475	0.032	0.007
P值		1.000		0.224	0.858	0.935

组别	例数	发热(例)	尿量[ml，(±s)]	Wong-Baker疼痛评分[M(Q)]	血尿天数[d，(±s)]	输血量[ml，M(Q)]	抗生素使用时间[d，(±s)]
A组	21	3	1 523±312	6(4，8)	2.3±1.3	181(0，400)	3.4±1.2
B组	23	2	1 621±353	8(6，10)	1.4±0.8	435(400，600)	3.2±0.6
统计值		χ²=0.120	t=0.976	Z=2.669	t=3.053	Z=-3.800	t=0.738
P值		0.914	0.335	0.008	0.004	<0.001	0.464
组别	卧床时间[d，(±s)]	尿漏或尿性囊肿(例)	住院天数[d，(±s)]	住院花费[元，(±s)]	患肾滤过率(ml/min，(±s)]
A组	3.1±1.1	3	20±8	21 075±5 086	38±6
B组	3.1±1.2	3	18±7	33 629±4 748	27±15
统计值	t=0.024	χ²=0.014	t=0.462	t=6.248	t=2.144
P值	0.981	0.905	0.649	<0.001	0.043

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