摘要
目的总结负压封闭引流治疗气肿性肾盂肾炎的经验。方法回顾性分析郑州大学附属郑州中心医院2013年1月至2022年10月采用负压封闭引流治疗5例气肿性肾盂肾炎患者的临床资料。男1例,女4例;年龄(61.4±6.6)岁。临床表现为寒战、发热5例;腰痛5例;恶心、呕吐3例。4例合并电解质紊乱;4例肾功能异常。5例C-反应蛋白、降钙素原、白介素-6水平均高于正常值;3例白细胞、中性粒细胞计数高于正常值,1例均低于正常值。5例均合并糖尿病,2例合并输尿管结石并梗阻。根据文献报道的气肿性肾盂肾炎的CT检查结果分为Ⅰ~Ⅳ型:Ⅰ型为积气局限在肾集合系统内,Ⅲ型为积气蔓延至肾实质,Ⅲ型为积气或脓肿蔓延至肾周组织内,Ⅳ型为双侧气肿性肾盂肾炎或孤立肾气肿性肾盂肾炎。本组5例中Ⅲ型3例,Ⅳ型1例(双侧);1例为Ⅱ型进展为Ⅲ型。在控制血糖及应用广谱抗菌药物下,5例均行输尿管支架管置入术。3例行经皮肾穿刺引流,治疗无效后行负压封闭引流;2例直接行负压封闭引流,其中1例为Ⅳ型患者,1例CT检查提示肾积气重,正常肾实质少。负压封闭引流方法:手术打开肾积气囊并用半透膜封闭创面,在肾周放置泡沫海绵敷料负压冲洗,进行充分减压、引流。结果5例患者术后血常规白细胞及中性粒细胞计数趋于正常;C-反应蛋白、降钙素原、白介素-6等炎症指标较术前均呈不同程度下降趋势,且患者体温等指标渐趋于正常。1~3d更换一次负压封闭引流装置,需更换3~5次,经治疗2~8周,患者血常规及肾功能均恢复正常。随访3~24个月,均预后良好,无感染复发,随访过程中复查CT,未见肾脏萎缩。结论在内科治疗联合输尿管支架管置入及经皮肾穿刺引流效果不佳时,或结石合并梗阻无法有效穿刺引流时,应用负压封闭引流治疗气肿性肾盂肾炎,在减少手术难度的同时可保留肾脏。但本研究病例数量较少,结论需增大样本量进一步验证。
Objective To summarize the experience of vacuum sealing drainage(VSD)in treating emphysematous pyelonephritis.Methods The clinical data of 5 patients with emphysematous pyelonephritis treated with VSD from January 2013 to October 2022 in Zhengzhou Central Hospital Affiliated to Zhengzhou University were retrospectively analyzed.There wereⅠmale and 4 female patients.The average age was(61.4±6.6)years old.Clinical manifestations were chills and fever in 5 cases,lumbago in 5 cases.There were 3 cases of nausea and vomiting.Four cases were complicated with electrolyte disturbance.4 cases suffered abnormal renal function.The levels of C-reactive protein,procalcitonin and interleukin-6 were higher than normal in 5 cases.Leukocytes and neutrophils was beyond normal in 3 cases,and lower than normal in 1 case.Five cases were complicated with diabetes,and 2 cases were complicated with ureteral calculus and obstruction.According to the CT results of emphysematous pyelonephritis reported in the literature,it can be divided intoⅠ-Ⅳtypes.TypeⅠwas confined to the renal collecting system.TypeⅢwas confined to the renal parenchyma.TypeⅢwas confined to the renal parenchyma,and typeⅣwas bilateral emphysematous pyelonephritis or isolated renal emphysematous pyelonephritis.Of the 5 cases,3 were typeⅡand 1 was typeⅣ(bilateral).One case of typeⅡprogressed to typeⅡ.Under the controlling of blood glucose and applying broad-spectrum antibiotics,all 5 cases underwent ureteral stenting.Three patients underwent percutaneous renal puncture drainage,and VSD was performed after treatment failed.Among the two cases,one patient was typeⅣ.And the others CT showed that the kidney was heavy with gas and less normal renal parenchyma,and VSD was performed directly.The renal sac was opened surgically and the wound was sealed with a semi-permeable membrane.Foam sponge dressing was placed around the kidney for negative pressure irrigation for full decompression and drainage.Results The leukocytes and neutrophils of 5 patients returned to normal after operation.The inflammatory indicators such as C-reactive protein,procalcitonin and interleukin-6 showed a downward trend to varying degrees compared with those before operation.The vital signs such as blood pressure,heart rate and temperature of the patients gradually became normal and stable.The VSD was replaced once every 1 to 3 days and was replaced 3 to 5 times.After 2 to 8 weeks of treatment,the blood leukocytes and kidney function of the patient returned to normal.All patients were followed up for 3 to 24 months with good prognosis and no recurrence of infection.No renal atrophy was observed during intermittent CT examination.Conclusions When medical treatment combined with ureteral stent placement and percutaneous renal puncture drainage are not effective,or when stones are complicated with obstruction and puncture drainage is not effective,the use of VSD in the treatment of emphysematous pyelonephritis can reduce the dfficulty of surgery and preserve the kidney.However,the number of cases in this study is small,and the conclusion needs to be further verified by increasing the sample size.
作者
王朝阳
谢坤
张君
张俊强
张凯
Wang Zhaogyang;Xie Kun;Zhang Jun;Zhang Junqiang;Zhang Kai(Department of Urology,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450000,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2023年第11期836-840,共5页
Chinese Journal of Urology
关键词
肾盂肾炎
气肿性
负压封闭引流
经皮肾穿刺
引流
感染
治疗
Pyelonephritis
EImphysematous
Vacuum sealing drainage
Percutaneous renal puncture
Drainage
Infection
Treatment
