经皮肾穿刺造瘘术治疗气肿性肾孟肾炎10例

Percutaneous nephrostomy for emphysematous pyelonephritis(a report of 10 cases)

目的介绍经皮肾穿刺造瘘术治疗气肿性肾盂肾炎的手术方法及临床效果。方法对10例气肿性肾盂肾炎患者在连续硬膜外麻醉下实施经皮肾穿刺造瘘术治疗。其中左肾8例,右肾2例。其中4例因肾周积气部位较多放置2根造瘘管引流。术后定期随访6个月到3年。结果 10例患者手术均成功完成,联合内科治疗,其中8例患者生存,2例死亡,8例存活患者术后6个月后静脉肾盂造影和肾功能检查肾功能基本正常。结论气肿性肾盂肾炎成功治疗的关键是手术引流,同时积极控制血糖和广谱抗生素的应用。经皮肾穿刺造瘘术和传统肾脏切除术相比创伤小,有利于更好地保存肾脏功能,为气肿性肾盂肾炎的治疗提供了更好的选择。

Objective To evaluate the clinical feasibility of percutaneous nephrostomy for the treatment of emphysematous pyelonephritis（EPN）.Methods Data of 10 patients with EPN underwent percutaneous nephrostomy during 2006 to 2009 were analyzed retrospectively.Of the 10 cases,8 had operation in the left kidney and 2 in the right kidney.Results All operations were successfully completed.The diagnosis of EPN was confirmed by gas in the parenchymal or perinephric space as detected by abdominal X-ray or CT.Prompt efforts were taken to control diabetes and i.v.Antibiotics were administered.8 patients survived and 2 died.Conclusions Immediate surgery with glycemic control measures and antibiotics is crucial for the treatment of EPN.Percutaneous nephrostomy can be an effective treatment option.