气肿性肾盂肾炎11例诊疗分析  

Diagnosis and treatment of emphysematous pyelonephritis of 11 cases

作　　者：汪洋 李志鹏[2] 庞玮挺 张楠 王可兵 Wang Yang;Li Zhipeng;Pang Weiting;Zhang Nan;Wang Kebing(Department of Urology,Qianhai Shekou Free Trade Zone Hospital,Shenzhen 518000,China;Department of Urology,the Second Hospital Affiliated to Kunming Medical University,Kunming 650000,China;Department of Urology,the Second Affiliated Hospital of Hubei University of Scinece and Technology,Xianning 437000,China)

机构地区：[1]深圳市前海蛇口自贸区医院泌尿外科,深圳518000 [2]昆明医科大学第二附属医院泌尿外科,昆明650000 [3]湖北科技学院附属第二医院泌尿外科,咸宁437000

出　　处：《国际外科学杂志》2025年第2期113-117,I0005,共6页International Journal of Surgery

摘　　要：目的探讨气肿性肾盂肾炎的诊治策略。方法回顾性分析2016年3月—2022年6月3家医院收治的11例气肿性肾盂肾炎患者的临床资料,其中深圳市前海蛇口自贸区医院4例,昆明医科大学第二附属医院5例,湖北科技学院附属第二医院2例,结合文献复习并进行总结。11例患者中,男性2例,女性9例;年龄50~82岁;左侧6例,右侧4例,双侧1例;所有患者均合并2型糖尿病且血糖控制不佳。入院时临床表现为患侧腰痛8例,发热11例,恶心、呕吐5例,意识障碍3例,脓毒性休克3例,合并输尿管结石或肾结石5例。致病菌为大肠埃希菌8例,肺炎克雷伯菌2例,奇异变形杆菌1例。所有患者均接受急诊微创手术、抗感染、胰岛素控制血糖、补液及营养支持治疗。2例一期行输尿管支架置入术、二期行经皮穿刺引流术;3例行输尿管支架置入术;6例行经皮穿刺引流术。根据气肿性肾盂肾炎CT分型:Ⅰ型1例,Ⅱ型3例,ⅢA型2例,ⅢB型4例,Ⅳ型1例。结果11例患者均治愈,4例入住ICU,ICU停留时间为2~7 d;1例住院期间行肾切除术,1例随访中因患肾萎缩行肾切除术。采用泌尿系CT或B超随访12~18个月,11例患者均未见复发。结论气肿性肾盂肾炎是一种罕见且严重的肾实质坏死性感染疾病,推荐早期行泌尿系CT明确诊断,积极微创手术联合内科综合治疗可作为首选的治疗策略,如经上述治疗无效者,应考虑行患肾切除术。Objective To explore the diagnosis and treatment strategy of emphysematous pyelonephritis(EPN).Methods The clinical data of 11 cases patients with EPN admitted to 3 hospitals from March 2016 to June 2022 were retrospectively analyzed,among them,4 cases from Qianhai Shekou Free Trade Zone Hospital,5 cases from the Second Hospital Affiliated to Kunming Medical University,2 cases from the Second Affiliated Hospital of Hubei University of Scinece and Technology.Among the 11 patients,2 were males and 9 were females,aged 50-82 years;the lesions were located on the left side in 6 cases,right side in 4 cases and bilateral in 1 case;all patients had type 2 diabetes and poor glycemic control.The clinical manifestations at admission including back pain in 8 cases,fever in 11 cases,nausea and vomiting in 5 cases,disturbance of consciousness in 3 cases,septic shock in 3 cases,accompanied with ureteral or kidney stones in 5 cases.The pathogenic bacteria were Escherichia coli in 8 cases,Klebsiella pneumoniae in 2 cases and Proteus mirabilis in 1 case.All patients received minimally invasive surgery,anti-infection,subcutaneous injection of insulin,fluid rehydration and nutritional support after admission.2 cases had a combination of an initial ureteral stenting and second stage percutaneous drainage,3 patients underwent ureteral stent implantation,6 patients underwent percutaneous drainage.According to the CT classification of EPN,there were 1 case of typeⅠ,3 cases of typeⅡ,2 cases of typeⅢA,4 cases of typeⅢB,and 1 case of typeⅣ.Results All 11 cases were cured,4 cases were admitted to intensive care unit for 2-7 days,1 case underwent nephrectomy during hospitalization,and 1 case underwent nephrectomy due to renal atrophy during follow-up.After 12 to 18 months of follow-up with urinary CT or B-ultrasound,there were no recurrence cases.Conclusions EPN is a rare and serious renal parenchymal necrotic infection.Early urinary CT examination is necessary for the diagnosis,and positive minimally invasive surgery combined with

关 键 词：气肿性肾盂肾炎 糖尿病 感染 诊治 

分 类 号：R69[医药卫生—泌尿科学]