肾实质脓肿合并肾周围脓肿B型超声诊断(附8例分析)

肾实质脓肿合并肾周围脓肿系指肾部份实质及肾被膜外周围脂肪囊内的感染,此病並非少见,本院自1983～1985年经超声检查后手术或穿刺治疗8例.现报告如下:一、资料和方法本组病例男性5例,女性3例,共8例,年龄自14～64岁,均为单侧发病,症     

妊娠合并尿路感染88例分析

目的探讨妊娠合并尿路感染的起因、预防、治疗及转归。方法回顾分析88例妊娠尿路感染患者的临床资料。结果无症状菌尿患者64例,急性肾盂肾炎21例,急性膀胱炎3例,经及时诊断、治疗,均取得较好疗效,随诊无流产、死胎、畸形等报告。结论妊娠合并尿路感染经早发现、早诊断、早对症治疗可取得满意疗效。     

慢性肾感染的CT诊断

本文搜集30例慢性肾和肾周感染病例(肾结核13例,黄色肉芽肿性肾盂肾炎9例,肾脓肿及肾周脓肿8例)的CT资料,就慢性肾和肾周感染的CT诊断问题作一评价。     

妊娠合并急性肾盂肾炎的临床护理体会

对我院2012年5月²013年5月接诊的100例妊娠合并急性肾盂肾炎患者进行护理,分别从排便护理、心理护理、合理饮食护理、药物治疗期间的护理等四个方面出发,基于人性化护理的基础上,加强常规的护理。在经过精心的护理之后,100例妊娠合并急性肾盂肾炎患者中,共有99妊娠合并急性肾盂肾炎出院,其中一例因有其他并发症而继续治疗。护理在妊娠合并急性肾盂肾炎患者的病情好转和身体健康中有着重要的作用。从排便护理、心理护理、合理饮食护理、药物治疗期间的护理等四个方面出发的全方位护理是治疗妊娠合并急性肾盂肾炎的治疗的关键措施之一。     

妊娠合并急腹症51例临床分析

[目的]探讨妊娠合并急腹症的临床特点和诊断、治疗.[方法]回顾性分析本院2008年12月至2011年8月收治的51例妊娠合并急腹症临床资料.[结果]51例病例中,急性阑尾炎10例、泌尿系结石10例、卵巢肿瘤蒂扭转8例、急性胰腺炎4例、卵巢巧克力囊肿破裂3例、急性胆囊炎3例、穿透性胎盘植入3例、子宫不全破裂2例、子宫肌瘤红色变性2例、急性胃炎出血2例、肠梗阻2例、肾脓肿1例、脾破裂1例.手术治疗28例,保守治疗23例.[结论]临床工作中应加强对妊娠合并急腹症的认识,尤其是提高对妊娠合并外科急腹症的诊治水平,以减少误诊并及时并正确治疗,有利于母婴的预后.     

阑尾周围脓肿33例手术治疗分析

目的 探讨急性阑尾周围脓肿的临床特点、诊断方法、治疗结果和并发症.方法 对2001-08-2011-08收治的2 862例急性阑尾炎患者中33例急性阑尾周围脓肿患者的临床资料进行回顾性分析.结果 33例无一例死亡.发生切口感染2例,无腹壁窦道形成、盲肠瘘、腹腔残余脓肿.平均住院天数13 d.结论 急性阑尾周围脓肿不是手术治疗的禁忌证,积极采取合适的手术治疗,腹腔置胶管引流,及时控制炎症,积极纠正脱水、电解质紊乱与酸中毒,手术治疗较非手术治疗治愈率高,缩短住院日,减少并发症.     

急性局限性细菌性肾炎二例误诊为肾癌

急性局限性细菌性肾炎 (ａｃｕｔｅｆｏｃａｌｂａｃｔｅｒｉａｌｎｅｐｈｒｉｔｉｓ,ＡＦＢＮ)是急性肾盂肾炎进一步发展至肾脓肿的中间过程 ,类似肾脓肿的亚急性和慢性经过。影像学易误诊为肾肿瘤。我们有 2例误诊为肾癌而手术 ,教训深刻。现报告如下。1　病例资料【例 1】　男 ,6 5岁。因发热、胸痛、伴尿频、尿急、尿痛就诊。查尿蛋白 (2 +) ,白细胞 30～ 4 0 /ＨＰ ,尿糖(3+) ,于 1989年 4月 14日以肾盂肾炎入院。既往有糖尿病史。Ｂ超检查示右肾下极外侧、肾实质内有一直径约 3 5ｃｍ的不均质低回声团块向肾外突出 ,轮廓模糊 ,外形不…     

双J管置入治疗肾积水合并急性肾盂肾炎30例

目的:探讨经膀胱镜置入双J管治疗肾积水合并急性肾盂肾炎的效果。方法:回顾性总结经膀胱镜置入双J管治疗的30例肾积水合并急性肾盂肾炎患者的临床资料。结果:全部患者于置管后体温在1～4d内恢复正常,血白细胞计数在3～6d内恢复正常,尿白细胞数在8～14d降至正常。在梗阻病因解除后,内置双J管在4～6周内拔除。结论:双J管置入治疗肾积水合并急性肾盂肾炎安全、有效,并可为进一步处理梗阻病因创造条件。     

肾静脉血栓形成的实验室检查及诊断价值

1引言 肾静脉血栓指肾静脉主干和(或)分支内血栓形成,导致肾静脉部分或全部阻塞而引起的一系列的病理改变和临床表现.它常在下列情况中发生:①血液高凝状态;②肾静脉受压;③肾静脉血管壁受损.据统计,20%～50%的肾病综合征病人并发此病.急性肾静脉血栓严重者有典型表现,即剧烈腹痛或腰痛、肉眼血尿、大量尿蛋白、少尿、肾功能突然恶化、肾小球滤过率下降,少数伴有发热.双侧肾发生急性肾静脉血栓形成或原一侧肾无功能而另一侧肾发生肾静脉血栓形成可出现急性肾衰竭.因此,及早诊断和及时溶栓治疗对改善预后至关重要.实验室检查和影像学检查是目前诊断肾静脉血栓形成的常用方法.     

肾穿刺活体组织检查的护理

我院内科对90例肾脏病患者进行了肾穿刺,现将护理体会介绍如下。一、适应证及禁忌症原发性肾小球疾病和全身疾患累及肾脏者,需确定其病变性质和病理类型;原因不明的持续性蛋白尿及肾性血尿者,需明确诊断。移植肾的排异反应;有明显出血倾向或血小板少于8万/立方厘米,凝血酶元时间大于16秒;晚期尿毒症病人或年迈者,血压超过160/110mmHg;肾片明显萎缩者,游走肾、多囊肾或肾脏囊肿性病变都不宜做肾穿。肾脏感染性疾病,如肾结核,肾脓肿和急性肾盂肾炎,     

Acute complicated pyelonephritis: contrast-enhanced ultrasound

Imaging is required if complication is suspected in acute pyelonephritis to assess the nature and extent of the lesions, and to detect underlying causes. The current imaging modality of choice in clinical practice is computed tomography. Because of associated radiation and potential nephrotoxicity, CEUS is an alternative that has been proven to be equally accurate in the detection of acute pyelonephritis renal lesions. The aims of this study of 48 patients are to describe in detail the CEUS findings in acute pyelonephritis, and to determine if abscess and focal pyelonephritis may be distinguished. Very characteristic morphologic and temporal patterns of enhancement are described. These allow differentiation of focal pyelonephritis from renal abscess, and detection of tiny suppurative foci within focal pyelonephritis. The detection of abscesses is important because follow-up in 25 patients revealed a longer clinical course. Typical pyelonephritis CEUS features permit distinction from other renal lesions. As a whole, CEUS is an excellent tool in the work-up of complicated acute pyelonephritis, so it may be considered as the imaging technique of choice in the evaluation and follow-up of these patients who frequently are very young, so as to minimise radiation exposure.     

Acute primary pyelonephritis or active phase of a latent form of chronic pyelonephritis?

Analyzing the data of a comprehensive examination of 372 patients admitted to hospital with a distinct clinical picture of acute pyelonephritis, the author shows that out of these patients' population, 278 (74.8%) had an active form of chronic disease running a latent course. At the same time 40.4% of cases were diagnosed to have chronic renal failure (CRF), stages IB-IIB. To determine the genuine character of renal injury, the author thinks it necessary to regard the symptom-complex of acute pyelonephritis as a consequence of the pyelonephritic process itself. In complicated cases of the diagnosis, biopsy of the kidney concerned is required. In 176 patients the final diagnosis was established by uroradiological examination, in 59 by means of the use of laboratory methods, and in 137 by biopsy of the involved kidney. It is recommended that patients with renal pathology should be kept under prolonged dispensary observation, particularly those with an initial stage of CRF.     

Prevention of acute and chronic ascending pyelonephritis in rats by aminoglycoside antibiotics accumulated and persistent in kidneys.

Gentamicin, because it is stored in renal tissues, can prevent acute retrograde pyelonephritis. Since different aminoglycosides accumulate and persist to various degrees in the kidney parenchyma, the prophylactic activities of gentamicin, tobramycin, amikacin, and netilmicin were compared. The four antibiotics were given intramuscularly to rats 3 days before initiating ascending unilateral pyelonephritis with Escherichia coli. Despite different degrees of renal accumulation at the time of infection (tobramycin and amikacin accumulated significantly less), all four aminoglycosides displayed similar protection against ascending pyelonephritis. This protection was conferred in the absence of active antibiotic detectable in the urine and was therefore attributed to antibiotic stored in the renal parenchyma. Those animals that developed pyelonephritis despite aminoglycoside prophylaxis had less severe acute kidney infection and inflammation. This resulted 3 months later in an almost complete protection against renal scarring (chronic pyelonephritis). These results in rats suggest that renal accumulation and persistence of aminoglycosides may be used to advantage in the prophylaxis or in the treatment of kidney infections.     

彩超引导穿刺肾结核并发脓肿及肾周脓肿的临床应用价值

目的：探讨介入性超声在肾结核并发脓肿及肾周脓肿中的诊断和治疗价值。方法：本组病例共36例。临床诊断肾周脓肿22例，肾结核并发脓肿14例，均在彩超引导下穿刺，部分患置入引流管定期反复冲洗，抽取液送病检、生化、培养及药敏。结果：14例临床诊断肾结核并发脓肿均行穿刺抽脓。其中12例临床诊断肾结核并发脓肿与病检及培养、生化诊断相符，其诊断符合率达85％，另2例经病检及培养后，诊断为非特异性感染性肾脓肿。22例肾周脓肿中12例行穿刺抽脓冲洗，1例置管引流，穿刺成功率达100％。结论：介入性超声在肾结核并发脓肿及肾周脓肿的诊断和治疗中具有重要的临床应用价值。     

The role of emergency ultrasound for evaluating acute pyelonephritis in the ED

Background

Controversy remains over the imaging method of choice for evaluating acute pyelonephritis (APN) in the emergency department (ED).

Objective

The aim of the study was to determine the efficacy of ultrasound in the diagnosis and management of patients presented to the ED with APN.

Methods

This was a retrospective study of prospectively collected data. A cohort of ED patients diagnosed as APN were prospectively registered, and their medical records were then retrospectively reviewed for the presence of complications (admitted >14 days, admission to intensive care unit, or received invasive procedures), significant abnormalities (hydronephrosis, polycystic kidney diseases, renal abscess, emphysematous pyelonephritis), and mild abnormalities (cysts, stones, swelling).

Results

The study included 243 patients. Most of the patients received one or more renal imaging studies (n = 206) and 39.5% of which were considered abnormal. The rates of significant abnormalities on different imaging methods were Kidney-ureter-bladder (KUB), 16.3%; emergency ultrasound (EUS), 39.6%; combination of KUB and EUS, 56.6%; and computed tomography, 58.8%. Factors contributed to complicated APN were elderly, male, a history of preexisting renal diseases, current use of catheters, previous renal calculi, and diabetes mellitus. Significant abnormalities can be identified by EUS in 61% of patients with complicated APN. In fact, the presence of significant sonographic abnormalities effectively diverted 34.3% of patients to receive surgical interventions (percutaneous nephrostomy, abscess aspiration, ureteroscopic stone manipulation, lithotripsy, or nephrectomy).

Conclusion

Structural abnormalities are not uncommon in ED patients with APN. Early assessment of these patients with EUS is likely to have a great impact on their diagnosis and management.     

急性肾盂肾炎的超声诊断

目的探讨急性肾盂肾炎的超声表现。方法回顾性分析52例经临床和实验室检查确诊的急性肾盂肾炎患者的声像图资料,重点分析肾盂壁声像变化。结果本组52例急性肾盂肾炎中有39例显示肾盂壁增厚,声像图表现有3种形式:“双线征”、“低回声带征”及“三线征”。结论利用肾盂壁增厚等声像改变,结合临床及实验室检查可进行急性肾盂肾炎的超声诊断,尤其对于临床表现不典型的病例,诊断意义更大。     

慢性肾脏病发生急性肾损伤临床分析

目的探讨慢性肾脏病合并急性肾损伤的病因、临床特点及治疗与转归情况,提高急性肾损伤的防治水平。方法对慢性肾脏病发生急性肾损伤68例住院患者的临床特点进行回顾性分析。结果慢性肾脏病合并急性肾损伤的临床特征表现为短时间内肾功能急剧恶化。所有患者均给予激素和细胞毒药物,同时给予控制感染、利尿、抗凝等综合治疗,其中32例进行血液透析治疗,27例肾功能恢复。结论慢性肾病并发急性肾损伤临床并不少见,一旦确定诊断并给予及时治疗,多数患者预后较好,肾功能可恢复正常。     

Xanthogranulomatous Pyelonephritis: A Clinical Analysis

Xanthogranulomatous pyelonephritis (XGP) is an inflammatory form of chronic renal disease with the characteristics of pyelonephritis. It is associated with staghorn nephrolithiasis, kidney tissue damage, renal function loss, and a nonfunctional kidney. XGP can be confused with neoplastic or inflammatory renal conditions due to its indistinguishable imaging and its vague clinical presentation. The treatment of choice is nephrectomy. Only a few cases of XGP have been treated medically. XGP should be managed by urology and nephrology providers. The nurse practitioner should refer patients with recurrent or persistent urinary tract infections, renal stones, staghorn calculi, or pyelonephritis to nephrology and urology specialists for further evaluation and management.     

多层螺旋CT增强扫描对慢性肾盂肾炎的诊断价值

目的：研究多层螺旋CT（MDCT）增强扫描对慢性肾盂肾炎的诊断价值。方法：病例组：2008年3月至2009年3月经我院诊治的慢性肾盂肾炎患者30例，均行MDCT增强扫描及静脉肾盂造影（IVP）检查，两者间隔时间不超过1周；对照组：同期无肾脏疾患，无尿路感染史，因其他原因来做腹部CT增强扫描的患者25例。由两名不同年资的腹部影像医师对拟定的征象进行观察、评价。结果：两医师对本组病例的诊断一致性极佳（K=0．812，P〈0．05）。病例组30例，双肾病变14例，单肾病变16例。单肾病变中，左肾12例，右肾4例。MDCT增强扫描显示肾盏轻度变形2例（6．7％），肾盏裸露18例（60．0％），实质凹陷征23例（76．7％），肾盂轻度扩张积水21例（70．0％），肾盂壁增厚、强化21例（70．0％），肾功能减退15例（50．0％）。5例（16．7％）仅表现为肾盂壁增厚、强化。MDCT增强扫描与IVP对肾实质凹陷征，肾盂壁增厚、强化及肾盏轻度变形的显示率有统计学差异（P〈0．05）。结论：MDCT增强扫描能清晰地显示慢性肾盂肾炎的病理变化。与IVP比较，它能提供更多肾实质的信息，对判定慢性肾盂肾炎所造成的肾脏损害程度及疾病预后具有很高的价值，不过对肾盏轻度变形的显示有赖于延迟扫描。