气肿性肾盂肾炎3例报告并文献复习

Emphysematous pyelonephritis(report of 3 cases and literature review)

目的探讨气肿性肾盂肾炎的临床诊治特点。方法总结3例气肿性肾盂肾炎患者的临床资料。本组均为糖尿病患者,均有腰腹痛症状、白细胞增多和不同程度肾功能损害,CT扫描见患肾增大、肾实质及(或)肾周围有大量气体。结果3例患者均静脉使用抗生素。1例手术引流、1例内引流、1例先行脓肿引流最终行肾切除,病情均得到改善。结论CT可助早期诊断气肿性肾盂肾炎,抗生素联合肾周引流术治疗效果好,必要时需行肾切除术。

Objective To study the diagnosis and treatment of emphysematous pyelonephritis. Methods The data 3 patients with emphysematous pyelonephritis was retrospectively analyzed. All patients were diabetic, presenting symptoms including fever, chills, nausea, vomiting, and abdominal pain. All cases had leukocytosis and impaired renal function. Computed tomography （CT） scan disclosed emphysematous pyelonephritis in 3 cases （gas within renal parenchyma and/or perirenal tissue）. Results All patients received intravenous antibiotics. One patient underwent abscess percutaneous drainage; 1 case had J-stent placement, and one patient ultimately required surgical exploration and nephrectomy. All the patients＇ conditions were improved and they were discharged. Conclusion CT scan is an efficient imaging method for early diagnosis, guiding the drainage procedures and follow-up of emphysematous pyelonephritis. Antibiotic therapy combined early with drainage is an acceptable alternative, but nephrectomy is necessary when needed.