Ng C K, Yip S K H, Sim L S J, Tan B H, Wong M Y C, Tan B S, Htoo A
Department of Urology, Singapore General Hospital, Singapore.
Asian J Surg. 2002 Jul;25(3):215-9. doi: 10.1016/S1015-9584(09)60178-0.
The aim of this study was to evaluate the efficacy of percutaneous nephrostomy (PCN) drainage for the interim management of pyonephrosis.
Ninety-two consecutive patients [29 men, 63 women; mean age, 57 years; range, 23 to 88] who underwent PCN for the treatment of pyonephrosis from 1996 to 1999 were evaluated retrospectively. The clinical presentation, bacteriology and patient outcomes were analyzed.
The majority [77%] of patients had underlying obstructing urinary calculi. Other causes of obstruction included strictures [9%], papillary necrosis [7%], pelvi-ureteric junction obstruction [4%] and malignant stricture [3%]. The microorganisms cultured were Escherichia coli [30%], Klebsiella [19%], Proteus [8%], Pseudomonas [5%], Enterococcus [5%], and Candida spp [5%]. The microorganisms were sensitive to gentamicin [79%], ceftriaxone [71%], cephalexin [54%], nitrofurantoin [40%], cotrimoxazole [35%], nalidixic acid [32%] and ampicillin [29%]. Only 30% of bladder urine cultures were positive for microorganisms; the addition of PCN cultures improved this yield to 58%. The antibiotic regimen was revised according to the PCN culture whenever there was a discrepancy. After PCN, 69% of patients underwent minimally invasive procedures as definitive treatment of the obstructing lesion. Only 14% of patients required open surgery. There was low procedure-related morbidity [14%] and low overall mortality [2%].
PCN cultures yield important bacteriological information. The procedure is associated with minimal morbidity, facilitates definitive treatment and provides therapeutic benefit.
本研究旨在评估经皮肾造瘘术（PCN）引流对肾积脓的临时治疗效果。
回顾性评估了1996年至1999年间因肾积脓接受PCN治疗的92例连续患者[29例男性，63例女性；平均年龄57岁；范围23至88岁]。分析了临床表现、细菌学及患者预后。
大多数患者[77%]有潜在的梗阻性尿路结石。其他梗阻原因包括狭窄[9%]、乳头坏死[7%]、肾盂输尿管连接部梗阻[4%]和恶性狭窄[3%]。培养出的微生物有大肠杆菌[30%]、克雷伯菌[19%]、变形杆菌[8%]、假单胞菌[5%]、肠球菌[5%]和念珠菌属[5%]。这些微生物对庆大霉素敏感的占[79%]、头孢曲松[71%]、头孢氨苄[54%]、呋喃妥因[40%]、复方新诺明[35%]、萘啶酸[32%]和氨苄西林[29%]。仅30%的膀胱尿液培养微生物呈阳性；加上PCN培养后，这一阳性率提高到58%。每当结果出现差异时，根据PCN培养结果调整抗生素治疗方案。PCN术后，69%的患者接受了微创手术作为梗阻病变的确定性治疗。仅14%的患者需要开放手术。手术相关发病率低[14%]，总体死亡率低[2%]。
PCN培养可提供重要的细菌学信息。该手术发病率极低，有助于确定性治疗并带来治疗益处。
