100广州医药2019年7月第50卷第4期气肿性肾盂肾炎的临床诊疗
邓向荣杨文俊
广州市第一人民医院(广州510180)
【摘要】目的气肿性肾盂肾炎(emphymatous pyelonephritis,EPN)作为罕见的泌尿外科急症，治疗
方式至今仍存在争议，本文旨在探讨治疗EPN时穿刺引流以及急诊肾切除的优缺点，为EPN的诊疗提供临床依
脚美甲图片据。方法回顾性分析11例EPN临床资料，并复习最新相关文献，综合分析该疾病的的治疗方式及预后。结果
11例EPN中诊断为I型4例，II型7例，就诊时发生感染性休克2例且均为I型。1例I型EPN患者接受经皮穿刺
引流术后感染控制不良，于次日行急诊肾切除术；其余3例I型EPN均直接行急诊肾切除术；所有I型EPN患者
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变开头的四字成语术后均转入ICU治疗，死亡1例，生存率为75%o7例II型EPN均急诊行经皮穿刺引流术，留置2根或以上引流
管3例，术后2例转入ICU，择期切除无功能肾2例，保肾率为72%，所有患者均痊愈。结论急诊肾切除术创
伤大，但可及时清除感染的坏死组织，适用于I型EPN，可提高患者生存率；而经皮穿刺引流术创伤小、操作简
单，适用于II型EPN，可以最大程度的挽救患肾功能。
建筑承包【关键词】气肿性肾盂肾炎；肾切除术；经皮引流术；电子计算机断层扫描
DOI：10.3969/j.issn.1000-8535.2019.04.024
Emphymatous pyelonephritis:clinical diagnosis and treatment
安全驾驶心得体会DENG Xiangrong,Yang Wenjun
Guangzhou First People's Hospital,Guangzhou510180,China
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[Abstract]Objective The treatment of emphymatous pyelonephritis(EPN),as a rare urological emergency,re
mains controversial.This paper aims to explore the advantages and disadvantages of percutaneous drainage and emergency nephrectomy in the treatment of EPN,so as to provide a clinical spectrum for the treatment of EPN.Methods11cas of EPN hospitalized between May2005and August2018were retrospectively analyzed；contemporary literature was reviewed concurrently.Results Among the11cas of EPN,4cas were diagnod as type I and7cas as type II.Septic shock occurred
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in2patients,all of whom were type I.One ca of type I EPN underwent percutaneous drainage under the guidance of emer
gency ultrasound but the infection was poorly controlled,emergency nephrectomy was performed the next day.The remaining
3cas were all treated with direct emergency nephrectomy.All type I cas were transferred to ICU and1ca died with a survival rate of75%.All type II EPN underwent emergency percutaneous drainage,with3cas indwelling2or more drain
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age tubes.2cas were transferred to ICU postoperatively.Elective nephrectomy was performed in2cas with kidney preservation rate of72%.All type II cas were cured eventually.Conclusion Emergency nephrectomy,although more traumatic,could timely remove the infected necrotic tissue,which is suitable for type I EPN and can improve the survival rate. Percutaneous drainage is simple,minimally invasive and more suitable for type II EPN,which can save the kidney maximum-
[Key words]Emphymatous Pyelonephritis；Nephrectomy；Percutaneous drainage；CT scan
气肿性肾盂肾炎(emphymatous pyelonephritis,EPN)，是一种罕见的泌尿外科急症，表现为急性肾实质及肾周组织炎性坏死，合并肾实质、肾周以及集合系统出现特征性的气肿形成⑷。EPN 是致死性疾病⑵，如未能及时诊断及治疗，死亡率会超过50%，死因往往是感染性休克的并发症。鉴于EPN的罕见性，目前仍无法进行系统的前瞻性研究，国内外的文献报道亦多以病例报告为主，从而导致EPN的最佳诊疗方案至今尚未达成共识。现将在2005年5月-2018年8月期间收治的11例EPN报告如下，旨在探讨不同分型EPN的最佳治疗方案。
1资料与方法
1.1临床资料
根据Wan⑶等提出的分型方法，将11例EPN 分为两型，I型4例病情危重，II型7例病情较稳定；女性患者9例，男性患者2例；右侧肾脏病变7例，左侧4例；合并糖尿病9例。就诊时所有患者均出现高热寒战，体温达39.IT~40.5T，伴
