气肿性肾盂肾炎的临床诊疗  

Emphysematous pyelonephritis: clinical diagnosis and treatment

作　　者：邓向荣[1] 杨文俊[1] DENG Xiangrong;Yang Wenjun(Guangzhou First People's Hospital, Guangzhou 510180, China)

机构地区：[1]广州市第一人民医院

出　　处：《广州医药》2019年第4期100-103,共4页Guangzhou Medical Journal

摘　　要：目的气肿性肾盂肾炎(emphysematous pyelonephritis,EPN)作为罕见的泌尿外科急症,治疗方式至今仍存在争议,本文旨在探讨治疗EPN时穿刺引流以及急诊肾切除的优缺点,为EPN的诊疗提供临床依据。方法回顾性分析11例EPN临床资料,并复习最新相关文献,综合分析该疾病的的治疗方式及预后。结果11例EPN中诊断为Ⅰ型4例,Ⅱ型7例,就诊时发生感染性休克2例且均为Ⅰ型。1例I型EPN患者接受经皮穿刺引流术后感染控制不良,于次日行急诊肾切除术;其余3例I型EPN均直接行急诊肾切除术;所有Ⅰ型EPN患者术后均转入ICU治疗,死亡1例,生存率为75%。7例II型EPN均急诊行经皮穿刺引流术,留置2根或以上引流管3例,术后2例转入ICU,择期切除无功能肾2例,保肾率为72%,所有患者均痊愈。结论急诊肾切除术创伤大,但可及时清除感染的坏死组织,适用于Ⅰ型EPN,可提高患者生存率;而经皮穿刺引流术创伤小、操作简单,适用于Ⅱ型EPN,可以最大程度的挽救患肾功能。Objective The treatment of emphysematous pyelonephritis(EPN), as a rare urological emergency, remains controversial. This paper aims to explore the advantages and disadvantages of percutaneous drainage and emergency nephrectomy in the treatment of EPN, so as to provide a clinical spectrum for the treatment of EPN. Methods 11 cases of EPN hospitalized between May 2005 and August 2018 were retrospectively analyzed;contemporary literature was reviewed concurrently. Results Among the 11 cases of EPN, 4 cases were diagnosed as type Ⅰ and 7 cases as type Ⅱ. Septic shock occurred in 2 patients, all of whom were type Ⅰ. One case of type Ⅰ EPN underwent percutaneous drainage under the guidance of emergency ultrasound but the infection was poorly controlled, emergency nephrectomy was performed the next day. The remaining 3 cases were all treated with direct emergency nephrectomy. All type Ⅰ cases were transferred to ICU and 1 case died with a survival rate of 75%.All type Ⅱ EPN underwent emergency percutaneous drainage, with 3 cases indwelling 2 or more drainage tubes. 2 cases were transferred to ICU postoperatively. Elective nephrectomy was performed in 2 cases with kidney preservation rate of 72%. All type Ⅱ cases were cured eventually. Conclusion Emergency nephrectomy, although more traumatic, could timely remove the infected necrotic tissue, which is suitable for type Ⅰ EPN and can improve the survival rate. Percutaneous drainage is simple, minimally invasive and more suitable for type Ⅱ EPN, which can save the kidney maximumly.

关 键 词：气肿性肾盂肾炎 肾切除术 经皮引流术 电子计算机断层扫描 

分 类 号：R692.7[医药卫生—泌尿科学]