抗生素或手术治疗小儿膀回流症
Vassilios Fanos1, Luigi Cataldi
1Neonatal Intensive Care Unit, University of Cagliari, 09124 Cagliari, Italy. vafanos@tiscali.it
Lancet (London, England)
|November 9, 2004
概括
对于儿童的膀回流症 (VUR) 治疗仍有争议. 一项元分析发现VUR干预的不确定的益处和手术对抗生素的小优势.
科学领域:
- 儿科脏病学 儿科脏病学
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 基于证据的医学基于证据的医学.
背景情况:
- 膀回流 (VUR) 影响1-2%的儿童,并可能导致损伤.
- 关于VUR的治疗选择,包括观察,抗生素和手术,也在讨论中.
- 目前的指导方针建议在复发性尿路感染中进行手术,尽管使用抗生素,但脏损伤进展.
研究的目的:
- 为了评估VUR干预措施的好处,与没有治疗相比.
- 评估手术对抗生素预防的额外好处.
- 探索VUR管理的未来战略.
主要方法:
- 十项随机对照试验的元分析.
- 包括964名患有VUR的儿童.
- 评估的终点,如尿路感染发病率,损伤和功能.
主要成果:
- 关于识别和治疗VUR的临床益处存在不确定性.
- 外科手术对抗生素的额外好处是最小的.
- 目前的做法,如常规囊回路成像,需要重新评估.
结论:
- 新的VUR管理策略应该专注于量身定制的,不那么侵入性的方法.
- 未来的目标强调预防关膜损伤,而不是纠正尿路动脉异常.
- 基于VUR呈现的男孩和女孩的不同管理可能是必要的.
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