Rabii R, Joual A, Rais H, Fekak H, Moufid K, Bennani S, el Mrini M, Benjelloun S
Service d'urologie, CHU Ibn Rochd, Casablanca, Maroc.
Ann Urol (Paris). 2000 Jun;34(3):161-4.
Prior to the introduction of antibiotics, the treatment of pyelonephrosis frequently consisted of nephrectomy to remove the non-functional kidney, which was a potentially dangerous source of systemic infection. This approach was later modified as a result of the advances made in antibiotic therapy, and included vigorous antibiotic treatment and prompt drainage of the kidney. At present, percutaneous nephrostomy provides a means of draining off the pus and determining a possible residual renal function. In this study, 14 cases of pyonephrosis were observed over a 7-month period. Lumbar pain was noted in 70% of cases, painful lumbar contact in 5 cases and fever, shivering and pyuria in all cases. Cytobacteriological urine analysis showed the presence of Escherichia coli in 7 patients, Proteus in 4 patients, and in 3 cases abacterial leucocyturia; in 2 patients with only one functional kidney, renal insufficiency was observed. In all cases, the diagnosis was confirmed by ultrasonography. The main etiological factors were urinary lithiasis in 10 patients (71%), followed by uropathy of the pyeloureteral junction in 4 patients (29%). Treatment consisted of primary nephrectomy in 10 cases; in 3 cases, primary nephrostomy was performed with a positive outcome and recovery of renal function in 2 subjects; in one case of renal failure treated by nephrostomy followed by conservative surgery, the patient did not survive. In conclusion, nephrectomy is advocated as the treatment of choice in the case of a damaged kidney and a normal contralateral kidney. Conservative treatment should be envisaged particularly in the case of a single kidney, or if the patient's state of health is poor. The best treatment consists of the detection and cure of the lithiasis which is the main etiological factor in this pathology.
在抗生素问世之前，肾盂积脓的治疗常常是通过肾切除术来切除无功能的肾脏，因为它是全身性感染的一个潜在危险因素。后来，由于抗生素治疗取得的进展，这种方法得到了改进，包括积极的抗生素治疗和及时的肾脏引流。目前，经皮肾造瘘术提供了一种排出脓液并确定可能的残余肾功能的方法。在本研究中，在7个月的时间里观察了14例肾盂积脓病例。70%的病例有腰痛，5例有腰部压痛，所有病例均有发热、寒战和脓尿。细胞细菌学尿液分析显示，7例患者存在大肠杆菌，4例患者存在变形杆菌，3例为无菌性白细胞尿；2例仅有一个功能肾的患者出现肾功能不全。所有病例均通过超声检查确诊。主要病因是尿路结石10例（71%），其次是肾盂输尿管连接处病变4例（29%）。治疗包括10例行一期肾切除术；3例行一期肾造瘘术，2例效果良好且肾功能恢复；1例肾衰竭患者先行肾造瘘术，随后进行保守手术，但未存活。总之，对于一侧肾脏受损而对侧肾脏正常的情况，主张行肾切除术作为首选治疗方法。特别是对于单肾患者或患者健康状况较差的情况，应考虑保守治疗。最佳治疗方法是检测并治愈作为该病理主要病因的结石。
