肾自截伴流注脓肿1例报道并文献回顾  

Autonephrectomy complicated with gravitation cold abscess:a case report and literature review

作　　者：郑小龙 张锐[1] 卿绍攀 严芳林 赖仕章 蒋成[1] ZHENG Xiaolong;ZHANG Rui;QING Shaopan;YAN Fanglin;LAI Shizhang;JIANG Cheng(North Sichuan Medical College,Nanchong 637000,China)

机构地区：[1]川北医学院,四川南充637000

出　　处：《临床医学研究与实践》2022年第5期27-30,共4页Clinical Research and Practice

摘　　要：目的了解肾结核导致流注脓肿患者的临床表现、诊断、治疗及预后。方法对川北医学院附属医院骨科诊断的1例肾自截伴流注脓肿患者的临床表现、实验室及影像学检查、治疗和预后进行分析,并回顾和总结国内外迄今为止关于肾结核致腰大肌脓肿的文献报道。结果该例71岁女性患者以腰背部疼痛伴右臀部、右大腿根部包块处红肿热痛为主要症状,有低热、盗汗、全身乏力,无尿频、尿急、血尿、脓尿,结合病史、影像学和病理检查,考虑为右肾结核致肾自截合并右侧腰大肌、髂窝、腹股沟、大腿根部脓肿伴细菌感染,经抗结核药物治疗和脓肿切开引流术后,病情好转。回顾既往文献,共搜集到9篇文章22例患者,加上本次1例,共23例患者,其中女性12例,男性11例,患者多为中青年,多数无膀胱刺激征,其中20例确诊方式为组织病理检查,3例为抗酸染色(2例为引流液,1例为尿液)。多数患者经抗结核药物治疗、脓肿引流、患肾切除后病情好转,仅有1例复发,回顾该病例,该患者随访期间自行停止抗结核药物治疗。结论肾结核导致腰大肌脓肿极为少见,本例肾自截伴流注脓肿更为罕见,是肾结核发展到晚期向肾周侵犯的结果。此类患者多以腰背部胀痛或包块就诊,多数无膀胱刺激征,预防的关键是早期诊断和治疗,治疗以手术辅以抗结核药物为主,其中足疗程的抗结核药物治疗是避免复发的关键。Objective To understand the clinical manifestation,diagnosis,treatment and prognosis of patients with gravitation cold abscess caused by renal tuberculosis.Methods The clinical manifestation,laboratory and imaging examination,treatment and prognosis of a patient with autonephrectomy complicated with gravitation cold abscess diagnosed in the orthopedics department of the affiliated hospital of north Sichuan medical college were analyzed.The literature reports on psoas abscess callsed by renal tuberculosis at home and abroad so far were reviewed and summarized.Results The patient was a 71-years-old woman with low back pain,swelling and hot pain at the right buttocks and right thigh root mass as the main symptoms;she had symptoms of low fever,sweating and general fatigue,but no frequent urination,urgent urination,hematuria and pyuria.Combined with medical history,imaging and pathological examination,the patient was considered to have autonephrectomy caused by right renal tuberculosis combined with abscess at the right psoas muscle,iliac fossa,groin and thigh root with bacterial infection.After anti-tuberculosis drug treatment and abscess incision and drainage,the patients'condition improved.A total of 9 articles and 22 patients were collected by reviewing the previous literature,and there were 23 patients after adding 1 case this time,including 12 women and 11 men.Most of the patients were young and middle-aged,and most of them had no bladder irritation sign.Among the patients,20 cases were diagnosed by histopathological examination,and 3 cases were diagnosed by acid fast staining(two case were drainage fluid and one case was urine).Most patients improved after antituberculous drug treatment,abscess drainage and excision of affected kidney,while only one case recurred because of stopping antituberculous drug treatment during follow-up.Conclusion Psoas abscess caused by renal tuberculosis is very rare,autonephrectomy complicated with gravitation cold abscess reported in this paper is extremely rare,which is the resul

关 键 词：肾结核 肾自截 腰大肌脓肿 流注脓肿 

分 类 号：R527.1[医药卫生—内科学]