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頁籤選單縮合
題名 | 氣腫性腎盂腎炎--10病例分析和文獻回顧=Emphysematous Pyelonephritis Analysis of Ten Cases and Literature Review |
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作者 | 潘吉豐; 彭國權; 陳漢湘; 葉瑞圻; Pan, Chi-fong; Pang, Kwok-kuen; Chen, Han-shiang; Yeh, Jui-chi; |
期刊 | 內科學誌 |
出版日期 | 19981200 |
卷期 | 9:4 1998.12[民87.12] |
頁次 | 頁207-213 |
分類號 | 415.8135 |
語文 | chi |
關鍵詞 | 氣腫性腎盂腎炎; 糖尿病; 敗血症; 外科引流; 腎切除手術; Emphysematous pyelonephritis; Diabetes mellitus; Sepsis; Surgical drainage; Nephrectomy; |
中文摘要 | 氣腫性腎盂腎炎(emphysematous pyelonephritis)是一種產氣性的腎臟感染疾病 ;雖罕見,但具高度致命性,臨床上對此病應具高度警覺性,故在此提出報告和文獻回顧。 本文乃收集自 1989 年至 1998 年,於臺東馬偕醫院確定診斷為氣腫性腎盂腎炎的病例,共 10 例加以分析:年齡分佈從 44 到 77 歲。男女各有 2 及 8 位。10 例皆為糖尿病患。較 常發生之部位為左側腎臟,很少發生於雙側腎臟 (左側 5 例, 右側 4 例,雙側 1 例 )。 最常見的致病菌種是大腸桿菌 (E.coli) 9 例, 其次是肺炎克雷白氏桿菌 (Klebsiella pneumonia)2 例,且有 4 例於培食中長出兩種以上菌種。 除了抗生素及輸液支持外,2 例 接受外科引流,5 例接受腎臟切除手術。 10 例中有 9 例存活,僅 1 例死亡 (為接受腎臟 切除者 )。分析不良預後的預測因子為:未能早期診斷並接受適當治療、就診時已明顯敗血 症及賢實質破壞嚴重。由於此病常見的症狀,包括發燒、畏寒、腰脅疼痛等,與一般上泌尿 道感染類似,並無任何特異性;但此病易併發敗血症而導致休克死亡,故在臨床上應有高度 警覺性:如果有腎盂腎炎症候的病人,尤其是糖尿病患,當有持續發燒、明顯敗血症現象或 對抗生素治療反應不佳時,氣腫性腎盂腎炎應列入考慮。予早期診斷 (藉由高度警覺性及適 時腹部影像檢查,尤以電腦斷層攝影最佳 ),並儘早在積極內科治療無效時,給予外科引流 或腎臟切除手術,當可減低死亡率。 |
英文摘要 | Emphysematous pyelonephritis is a rare, rapidly progressive, life-threatening infection of the renal parenchyma and perirenal tissue, which is characterized by the presence of gas within the renal parenchyma and occasionally, perirenal tissue. The disease is primarily encountered in the patients with diabetes mellitus and/or urinary tract obstruction. It most commonly is unilateral. The clinical presentation is similar to that in uncomplicated pyelonephritis. But because of it's life- threatening potentail, which is due primarily to septic complication, it deserves special attention. A high index of suspicion coupled with radiographic imaging is essential to make a timely diagnosis and guide therapeutic intervention. Early aggressive therapy (combined medical and surgical) is the hall mark of successful treatment. Here, ten cases of emphysematous pyelonephritis which were diagnosed at Mackay Memorial Hospital, Tai-tung branch between 1989 and 1998 were analyzed and previous literatures were reviewed. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。