摘要
目的系统评价我国儿童尿道损伤(CUI)的外科诊治。方法检索中国生物医学文献数据库、PubMed截至2008年9月的CUI相关文献,采用JBI叙述性研究质量评价方法评估纳入文献质量,提取有效数据后以Excel2003建立数据库,对纳入文献的特征、研究质量、研究内容、病例特征、诊断与处理、结局评价及随访等进行统计分析。结果纳入22个研究,1019例CUI患者,以男童为主。22个研究均为回顾性病例分析,大多数方法学质量较低。CUI以交通事故致骨盆骨折或骑跨伤等意外伤为主。16个研究报道采用较为客观的诊断方法(膀胱/尿道造影、手术探查及尿道探条检查)。损伤部位以后尿道为主,多为陈旧性尿道损伤(狭窄或闭锁);分为早期处理(一期、延期手术)与二期手术,治疗方法依据损伤部位与病理类型而不同。14个研究明确描述外科干预成功或治愈结局,其治愈/成功率不等(52%～100%)。除4个研究外其余研究均报道了不完全随访(3个月～16年),仅部分研究采用客观结局(尿路造影、尿道扩探及尿控功能评价)评价。并发症涉及尿道狭窄、尿瘘形成、尿失禁及性功能障碍等。结论我国CUI临床研究质量偏低,缺乏前瞻性随机临床试验。尿道损伤多见于男童,以后尿道损伤(陈旧伤)为主。由于纳入研究疾病与治疗异质性未能对其进行合并分析,需要更多高质量证据。推荐临床与科研中遵循中华医学会泌尿外科分会制定的儿童尿道损伤诊治指南意见实施个体化外科处理。
Objective To review the surgical management for Chinese children urethral injury （CUI）.Methods According to the evidence-based medicine principal and the approach of systematic review,we searched Chinese Biomedicine Database and PubMed,all literature retrievals were updated until September 8th,2008.At least two reviewers independently screened the studies for eligibility,evaluated the quality with the Joanna Briggs Institute critical appraisal checklist for descriptive/cases series studies and extracted the data with excel 2003 from the eligible literatures,with confirmation of cross-check.Different views were consulted by the third party.The characteristics of literature,research quality,study content,cases characteristics,diagnosis and treatment,outcome appraisal and follow-up were analyzed.Results A total of 22 studies involving 1019 patients were included,most patients were male children.All 22 studies were descriptive researches and the study quality was low.The etiologies were mainly pelvic fracture and straddle injury as results of misadventure.The diagnosis was based on the relatively objective diagnostic tests such as urethrography,operations research and the exploration of urethral bougie etc in 16 studies.The most categories of CUI were obsolete urethral injuries such as stricture and atresia,the injury sites mainly lied in posterior urethra.The management of CUI were divided into the primary treatment included the first-stage operation and delayed-stage repair,and the second-stage management.Moreover,the individual operation was according to the injury sites and patterns.A total of 14 studies reported the outcomes of operation at various success rates （52%-100%）.Except 4 studies,the others reported incomplete follow-up time,from 3 months to 16 years,but few adopted objective methods such as urethrography and urodynamic test.The main complications were urethral stricture,urinary fistula and sexual dysfunction etc.Conclusion The quality of CUI studies was low for lack of prospective randomized controlled trials.The major patients were male children with posterior urethra injuries.Because of the heterogeneitiy of the individual case,different surgeon＇s managements and the variety of treatment options,we cannot make identical conclusion.We need more researches with high methodological quality.Moreover,we recommend that,following the clinical practice guideline of CUI made by Chinese Urological Association for the Chinese urologist,and then performing individual surgical management.
出处
《中国循证医学杂志》
CSCD
2010年第9期1063-1071,共9页
Chinese Journal of Evidence-based Medicine
关键词
儿童
尿道损伤
外科处理
叙述性研究
研究质量
系统评价
Children
Urethral injury
Surgical management
Descriptive study
Study quality
Systematic review
