儿童肾脓肿的保守治疗  

Conservative management of pediatric renal abscess

作　　者：罗添华[1] 张旭辉[1] 孟庆明[1] 孙玉芳 王玮 Luo Tianhua;Zhang Xuhui;Meng Qingming;Sun Yufang;Wang Wei(Department of Urology,Shanxi Children's Hospital,Taiyuan 030013,China)

机构地区：[1]山西省儿童医院泌尿外科,太原030013

出　　处：《中华小儿外科杂志》2021年第10期903-906,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨儿童肾脓肿的临床表现、治疗方法及预后情况。方法收集2016年1月至2020年1月山西省儿童医院收治的5例儿童肾脓肿患儿的相关资料。其中,男1例,女4例;患儿年龄范围为9个月至8岁,中位年龄为5岁;3例患侧为左侧,2例为右侧。患儿的首发症状2例为高热伴腹痛或者腰痛(其中1例并发感染性休克),1例单纯发热,1例发热伴脊柱侧弯,1例仅有呕吐伴头痛,无明显发热。体格检查提示3例患儿存在不同程度患侧腹部压痛和肾区叩击痛。5例患儿中4例白细胞计数、C反应蛋白、降钙素原、红细胞沉降率均异常升高,另1例正常。彩色多普勒超声检查提示患肾体积明显增大、饱满,实质内可见低回声区,回声不均,直径大小的范围为2.9~4.7 cm。CT检查提示患肾实质内局限性低密度区,1例左肾脓肿并发腰肌脓肿,1例右肾脓肿并发胰腺炎,肝门部胆管扩张,肝肾间隙及盆腔积液。所有患儿中,4例为单个局限性病灶,1例为多发小病灶,均不伴有先天性泌尿系统畸形。入院后均给予静脉滴注广谱抗生素治疗,疗程时间范围为1~4周。结果3例继发于尿路感染,2例病因不明。尿细菌学培养4例无细菌生长,1例为大肠杆菌。患儿经抗感染治疗痊愈,未行经皮引流或者手术治疗,无一例行肾切除术,预后良好。对所有患儿进行了门诊随访,随访时间范围为3~6个月。无血压升高的情况发生。1例患儿经彩色多普勒超声检查提示右肾实质残留1.4 cm的不均匀回声区,其余4例复查彩色多普勒超声提示肾实质未见明显异常,所有患儿均行放射性核素肾显像,其中4例未见明显肾瘢痕(相对分肾功能正常),1例患肾显像影略小于对侧肾(相对分肾功能为42%)。所有患儿均未再出现发热性尿路感染或者肾脓肿复发,目前仍在进一步随访中。结论对不存在先天性泌尿系统畸形的肾脓肿行保守治疗效果良好,一般不遗留肾瘢痕Objective To explore the clinical manifestations,treatment and prognosis of renal abscess in children.Methods From January 2016 to January 2020,the relevant clinical data were collected for 5 hospitalized children with renal abscess.There were 1 boy and 4 girls with a median age of 5(0.75-8.00)years.The involved side was left(n=3)and right(n=2).Initial symptoms were high fever with abdominal pain or lower back pain(n=2,1 case complicated with septic shock),simple fever(n=1),fever with scoliosis(n=1)and only vomiting with headache without marked fever(n=1).Physical examination revealed varying degrees of abdominal tenderness and percussion pain in renal area(n=3).Four cases had abnormal elevations of leucocyte,C-reactive protein,procalcitonin and erythrocyte sedimentation rate.Color Doppler ultrasonography revealed a larger volume of affected kidney with a diameter of 2.9 to 4.7 cm,hypoechoic parenchyma and uneven echoes.Computed tomography(CT)revealed localized hypodense areas in parenchyma of affected kidney.One case of left renal abscess was complicated by lumbar muscle abscess while another case of right renal abscess developed pancreatitis,hilar bile duct dilatation and hepatorenal space and pelvic effusion.The lesions were single localized(n=4)and multiple small(n=1).None of them was accompanied by congenital urinary malformations.After admission,intravenous broad-spectrum antibiotics were administered for 1 to 4 weeks.Results The etiology was urinary tract infection(n=3)and unknown(n=2).Urinary bacteriological culture indicated E.coli(n=1)and no growth(n=4).The infected child recovered after anti-infective treatment without percutaneous drainage or surgical treatment.None underwent nephrectomy with an excellent prognosis.During an outpatient follow-up period of 3 to 6 months,no hypertension occurred.Upon re-examination,one child had a residual heterogeneous echogenic area of 1.4 cm in right renal parenchyma.On radionuclide renal image,4 cases showed no significant renal scar(normal relative renal function)w

关 键 词：儿童 肾脓肿 保守治疗 

分 类 号：R726.9[医药卫生—儿科]