非特异性肾周围炎及肾周围脓肿诊治分析（附20例报告）

目的：报道我院近五年来收治的20例肾周围炎及肾周围脓肿病例，并对其诊断和治疗作出分析。方法：回顾性分析了自2005年1月～2010年8月期间住院的20例肾周围炎及肾周围脓肿患者的病例资料。收集分析的资料包括：临床症状及体征、合并症、影像学检查、实验室检查、细菌培养、治疗及预后。结果：20例病例中，肾周围炎5例，肾周围脓肿15例。最主要的临床表现是腰腹部疼痛、发热、腰腹部肿块，分别为16例（80％）、12例（60％）、5例（25％）。另外少见临床表现有血尿3例（15％）、尿频尿急尿痛2例（10％）、恶心呕吐腹胀1例（5％）。合并症可见糖尿病、泌尿系结石、慢性肾盂肾炎、输尿管移行细胞癌、腹膜后纤维化及肾盂输尿管连接部狭窄，分别为5例（25％）、5例（25％）、7例（35％）、1例（5％）、1例（5％）、1例（5％）。有7例患者做血、尿、脓培养，其中5例阳性（71．4％），致病菌主要为：大肠埃希菌、肺炎克雷白杆菌、变形杆菌，混合感染为2例（28．6％）。在所有患者中，单纯抗生素治疗者5例（25％），B超引导下穿刺引流者6例（30％）（4例复发需再次手术，其中3例行切开引流，1例肾切除），开放切开引流者5例（25％），行。肾切除者4例（20％）。19例患者痊愈出院，1例患者形成窦道，迁延不逾，无死亡病例。结论：随着B超、CT等影像学技术的进步和普及，肾周围炎及肾周围脓肿的诊断和治疗已有较大的改善，尽早行彻底引流及有力的抗生素治疗是疾病痊愈的关键。

The Diagnosis and Treatment of Non-Specific Perinephritis and Perinephric Abscesses(Report of 20 Cases )

Objective:The objective was to describe the last 5 years’ information of the patients with perinephritis or perinephric abscesses and discuss our experience of the diagnosis and treatment of perinephritis and perinephric abscesses at our hospital.Methods:The medical records of 20 patients with perinephritis or perinephric abscesses treated at our hospital from January 2005 to August 2010 were reviewed.The data collected included symptoms and physical examination,laboratory and radiologic evaluation,treatment,and clinical outcome.Results:Perinephritis were found in 5 patients,Perinephric abscesses were found in 15.The main symptoms and physical examination were lumbar or(and) abdominal pain、fever、flank or abdominal mass,respective 16(80%),12(60%)、5 (25%),The others were haematuria 3(15%)、frequent micturition、urgent micturition odynuria(10%)、nausea&.vomiting 1(5%).Urolithiasis(25%)、chronic pyelonephrins 7(35%)and diabetes mellitus 5(25%) were the most common complication.The others are transitional cell carcinoma of ureter 1(5%),retroperitoneal fibrosis 1(5%)and UPJO(5%).The results of urine culture and(or) blood culture and(or) abscess culture were available in 7 patients.The positive rate was 71.4%(5).Of all the patients,5 only received antibiotic therapy (25%).The others received an interventional treatment;percutaneous drainage 6(30%),surgical drainage 5 (25%) and nephrectomy 4(25%).Escherichia cob,Klebsiella pneumonia and Proteus mirabilis have become the most frequent isolated microorganisms.19 patients were cured on discharge from hospital.1 emerged sinus,and none died.Conclusions:The improvement and widespread availability of imaging studies(CT and US) in recent decades improved the diagnosis and treatment of perinephritis and perinephric abscesses.Early and absolute drainage and enough antibiotic therapy is the key point in the outcome of perinephritis and perinephric abscesses.