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The Comparison of Clinical Outcomes between Percutaneous Catheter Drainage and Surgical Drainage in Perinephric Abscesses
腎週圍膿瘍的經皮導管引流和外科引流臨床預後之比較
摘要
腎臟本身的感染，大致可分為腎膿瘍和腎周圍膿瘍(Perinephric abscess)Q而腎周圍膿瘍不是一個常見的疾病，大約每一萬住院患者中有0.4到4位。本文目的是想去比較經皮導管引流術(Percutaneous catheter drainage, PCD)和手術引流對腎周圍膿瘍的臨床預後之不同。我們分析民國89年1月1日至93年12月31日的電腦資料，一共找出260個急性腎臟感染的病例，從中發現27個腎周圍膿瘍的病例。回溯性分析一般人口學資料、誘發因子、病狀與徵候、實驗數據、住院診斷、微生物報告以及治療與預後。發現本院腎周圍膿瘍主要以女性居多，而較常見之誘發因子為糖尿病、泌尿道感染及腎結石。微生物報告發現最常見之致病菌為大腸桿菌(Escherichia coli)和克雷白氏肺炎桿菌(Klebsiella pneumoniae)。所有的病人皆有接受抗生素的治療，而且其中有12人（佔44.4%）接受經皮穿刺腎造口術，有11人（佔40.7%）接受手術引流。比較接受經皮導管引流術和手術引流兩組病人，發現人數、平均年齡、廷後診斷時間、血中白血球、C-反應蛋白、全身性發炎反應症候群、誘發因子皆無顯著差異；在住院天數方面，亦無差異。因此針對腎周圍膿瘍的病例，若能儘早安排經皮導管引流術合併較大之引流管，預後不錯。
並列摘要
Aim: A comparison of clinical outcomes between percutaneous catheter drainage (PCD) and surgical drainage in the management of perinephric abscesses was made in a contemporary cohort. Methods: We retrospectively reviewed the clinical features of perinephric abscesses in a single community-based hospital. Demographics, predisposing factors, symptoms and signs, laboratory data, diagnosis at admission, microbiological data, management and outcomes were recorded. Clinical outcomes were then compared between patients receiving PCD and surgical drainage. Results: Twenty-seven patients with perinephric abscesses were enrolled. Primary management involved a combination of antibiotic therapy and PCD for abscess in 12 (44.4%) patients. Eleven (40.7%) patients required surgical drainage for treatment of perinephric abscesses. No significant difference in the mean duration of hospitalization was found between the two groups (P=0.148). In addition, there was one mortality in the PCD group and another patient expired in the surgical drainage group due to multiple organ failure. Conclusions: The clinical outcome of perinephric abscess is dependent on early treatment and adequate drainage. PCD with a large-size catheter is less invasive and functions as a suitable choice for the draining of perinephric abscess, especially in critically ill patients.