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首页> 外文期刊>The journal of maternal-fetal & neonatal medicine >Antenatal intervention for congenital fetal lower urinary tract obstruction (LUTO): a systematic review and meta-analysis
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Antenatal intervention for congenital fetal lower urinary tract obstruction (LUTO): a systematic review and meta-analysis

机译：先天性胎儿降低尿路阻塞（LUTO）的产前干预：系统审查和荟萃分析

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Objective:To evaluate the effectiveness of antenatal intervention for the treatment of congenital lower urinary tract obstruction (LUTO) in improving perinatal survival and postnatal renal function. Methods:Electronic databases were searched from their inception until May 2018. Selection criteria included randomized controlled trials and nonrandomized studies including fetuses with ultrasound evidence of LUTO evaluating antenatal intervention for improving perinatal outcomes. Any type of antenatal bladder drainage technique was analyzed. The primary outcome was perinatal survival. The secondary outcome was postnatal survival with normal renal function. The summary measures were reported as summary odds ratio (OR) with 95% of confidence interval (CI). Results:Ten articles with a total of 355 fetuses were included in the meta-analysis. Inclusion criteria of the selected studies were singleton pregnancy with severe LUTO confirmed on detailed fetal ultrasound examination. Nine studies analyzed the efficacy of vesico-amniotic shunt performed in the second trimester. The overall estimate survival was higher in the vesico-amniotic shunt group compared to the conservative group (OR: 2.54, 95% CI: 1.14-5.67). 64/112 fetuses (57.1%) survived in the vesico-amniotic shunt group compared to 52/134 (38.8%) in the control group. Five studies reported on postnatal renal function between 6 months and 2 years. Rate of good postnatal renal function was higher in the vesico-amniotic shunt group compared to the conservative group (OR: 2.09, 95% CI: 0.74-5.9). Fetal cystoscopy was performed in only two included studies. Overall, 45 fetuses underwent fetal cystoscopy. The perinatal survival was higher in the cystoscopy group compared to the conservative management group (OR: 2.63, 95% CI: 1.07-6.47). Normal renal function was noted in 13/34 fetuses in the cystoscopy group versus 12/61 in the conservative management group at 6 months follow-up (OR: 1.75, 95% CI: 1.05-2.92) Conclusions:Antenatal bladder drainage appears to improve perinatal survival in cases of LUTO.
机译：目的：评价产前干预治疗先天性尿路梗阻（LUTO）改善围产期存活和产后肾功能的效果。方法：从他们的成立中搜索了电子数据库，直到2018年5月。选择标准包括随机对照试验和非扫描研究，包括具有超声波证据的胎儿，用于评估产前干预，以改善围产期结果。分析了任何类型的产前膀胱排水技术。主要结果是围产期存活。二次结果具有常规肾功能的产后存活。报告总结措施作为综合赔率比（或）置信区间95％（CI）。结果：在荟萃分析中包含总共355胎的十篇文章。所选研究的纳入标准是单身妊娠，严重卢塔证实了详细的胎儿超声检查。九项研究分析了在妊娠三个月的VESICO-amniotic分流的疗效。与保守基团（或：2.54,95％CI：1.14-5.67）相比，VESICO-amniotic分流组的整体估计存活率较高。 64/112胎儿（57.1％）在VESICO-amniotic分流组中存活，而对照组的52/134（38.8％）。在6个月和2年之间出现后肾功能的五项研究。与保守组（或：2.09,95％CI：0.74-5.9）相比，VESICO-amniotic分流组良好的产后肾功能率较高。胎儿膀胱镜检查仅在其中包括两个研究中进行。总体而言，45个胎儿接受胎儿膀胱镜检查。与保守管理组（或：2.63,95％CI：1.07-6.47）相比，膀胱镜检查中围乡存活率较高。在6个月的保守管理组中，在膀胱镜检查群中的13/34胎儿中患有正常的肾功能，在6个月内进行随访（或：1.75,95％：1.05-2.92）结论：产前膀胱排水似乎改善Luto病例中的围产期生存。

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