Emphysematous Pyelonephritis Concomitant with Perirenal Urine Leakage: A Case Report

產氣性腎盂腎炎併發腎周圍尿液滲漏：病例報告

楊石崇(Shi-Churng Yang) ； 林子興(Tzu-Hsing Lin) ； 李明輝(Ming-Wuei Lee)

《中華放射線醫學雜誌》 26卷5期 (2001/10) Pp. 227-232

摘要

產氣性腎盂腎炎是一種少見有致命危險的腎臟感染性發炎疾病。主要發生在糖尿病或有泌尿道阻塞的病患，女性好發率大於男性，而左腎產氣性腎盂腎炎機會大於右腎。早期正確的診斷以及積極的治療是非常必要的措施，以挽救產氣性腎盂腎炎患者的生命。我們提出一個產氣性腎盂腎炎的病例，這是一位48歲的糖尿病患者，因發燒、畏寒、嘔心、休克住院。腹部ｘ光素片、超音波都確定了左腎產氣性腎盂腎炎的診斷，但是顯影後腹部電腦斷層掃描才能清楚顯示腎臟受損程度，以及侵犯腎周圍和腎旁組織的範圍。在積極控制血糖、長期抗生素使用及經皮腎周圍引流的治療下，患者恢復情況良好。期間雖併發左腎周圍尿液滲漏，但並未因此延長住院療程。我們回顧了產氣性腎盂腎炎的文獻並討論了相關的流行病學、病理發生過程、電腦斷層的分類及分期和不同的治療組合。長期抗生素治療合併經皮腎周圍引流，對於產氣性腎盂腎炎的治療，是一種治癒率極高的治療組合；但是緊急腎臟切除術對於病情急速惡化者仍有其必要性。

關鍵字

產氣性腎盂腎炎 ； 電腦斷層 ； 腎周圍尿液滲漏 ； 經皮腎引流術

並列摘要

Emphysematous pyelonephritis (EPN) is a sever form of urinary tract infection presenting as gas-producing inflammation of kidney. All the EPN occur in the patients suffering from diabetic mellitus (DM) or urinary tract obstruction. It needs early diagnosis and aggressive treatment for the survival of the patients with EPN. We describe a case of extensive EPN concomitant with perirenal urine leakage in a 48-year-old female patient with DM who was successfully treated by the control of blood sugar, long-term antibiotics, and percutaneous drainage of perirenal gas and fluid. Literature of the EPN in respects of epidemiology, pathogenesis, pattern of computed tomographic features, and optimal therapeutical choices among different combinations of antibiotics, percutaneous drainage, and nephrectomy are reviewed and discussed. Antibiotics combined with percutaneous drainage is a good alternative for management of emphysematous pyelonephritis but surgical intervention is suggested if initial fulminate course is present.

並列關鍵字

Emphysematous pyelonephritis ； Computed tomography ； Perirenal urine leakage ； Percutaneous drainage