文章詳目資料

中華民國泌尿科醫學會雜誌

  • 加入收藏
  • 下載文章
篇名 Management of Renal Abscesses – 10 years of Experiences at Tri-Service General Hospital
卷期 7:3
並列篇名 腎臟膿瘍的治療-三軍總醫院十年經驗
作者 陳鼎源孫光煥李祥生程千里王曉暹馮超傑馬正平楊泰和于大雄
頁次 148-154
關鍵字 腎臟疾病膿瘍電腦斷層Kidney diseasesabscesscomputerized tomography TSCI
出刊日期 199609

中文摘要

腎臟膿瘍及腎周膿瘍位後腹腔,診斷較為困難,經常合併敗血性休克,造成較高之死亡率。為探討其臨床症狀,治療,及結果,本文回顧本院過去十年治療32例腎臟膿瘍及腎周膿瘍之經驗。這類病人常有一些罹病潛因包括糖尿病,尿路感染及腎臟結石。在診斷方面,腹部超音波及電腦斷層能及早辨識膿瘍的位置及大小,對於後續的治療及追蹤很有價值。最常見的致病菌是大腸桿菌及搭電勃氏桿著,合計佔百分之七十的病人;但金黃色葡萄球菌亦出現於兩例有皮膚感染之患者。在治療方面,有6例接受抗生素單一治療;有18例起初接受超音波導引經皮引流術,其中有7例必須進一步施行手術治療(含四例引流及三例腎切除;有6例直接使用手術引流或腎切除(含四例手術引流,一例腎切除及一例部份腎切除)。總共死亡共五例相當於16.7%。最終需要手術治療共十三例,佔43.3%。根據本院之經驗,合併有腎結石,多囊腎,無功能腎,多發性膿瘍或腎周膿瘍的病人多需要手術引流。總之必須善用診斷工具,早期診斷,並施以積極的治療,才能得到較好的結果。

英文摘要

Renal abscess, either intrarenal or peninephric, is a fatal disease when complicated with sepsis High morbidity and mortality rates are associated with delayed diagnosis, with vague symptoms derived from the retroperitoneum. For clarification of clinical presentation, treatment and outcome, a review was done of 32 patients who were diagnosed and managed as renal or perirenal abscesses at this Hospital from November 1986 to October 1995. The predisposing factors were diabetes mellitus, urinary tract infection or renal stones. Ultrasound and computerized tomography (CT) were valuable in early identifying the location and size of abscess and helpful in further therapy as well as follow-up. Esherichia coli (E. coli) and Klebsiella pneumoniae were the most common organisms (70%) identified. Staphylococcus aureus was found in two patients with infectious skin lesions. Six patients received effective antibiotics without surgery. Eighteen patients received sonoguided percutaneous abscess drainage (PAD) with antimicrobial therapy as initial treatment, seven of them received open surgery later, including multiple drainage in four and nephrectomy in three. The initial open surgeries done in six patients, included open drainage in four, nephrectomy in one and partial nephrectomy in one. One patient received PAD after open drainage for residual pus. Finally, a total of 13 (43.3%) patients had received open surgery during the hospital course. Five patients expired, including four who received PAD as initial therapy and one conservative treatment as mono therapy. These results indicated that early diagnosis and aggressive management attained better outcome, and appropriate systemic antibiotics and/or adequate drainage were successful treatments in most patients. Open drainage and nephrectomy were necessary in patients with multiple intrarenal abscesses, military abscesses, polycystic kidney disease, renal stone, resistance to antibiotics or with non-functioning kidney