Wang Jinn-Ming, Lim Hwee-Kheng, Pang Kwok-Kuen
Department of Urology, Mackay Memorial Hospital, Taitung, Taiwan.
Scand J Urol Nephrol. 2007;41(3):223-9. doi: 10.1080/00365590601017451.
The mortality rate among patients with emphysematous pyelonephritis (EPN) is high and the best therapy has long been debated.
Between January 1993 and December 2004, 26 patients diagnosed with EPN were treated at our hospital. Historical, demographic and laboratory data were obtained from medical records for analysis.
The mean age of the patients was 58.7+/-12.7 years. All patients had diabetes, and women outnumbered men (23:3). The clinical findings were non-specific. A plain abdominal X-ray was diagnostic in only 9/26 patients (36%), ultrasonography was accurate in 13 (50%) and CT was diagnostic in all cases. Eighteen patients survived, including all five treated with open drainage and three out of four treated with percutaneous drainage (although one of these later required nephrectomy), and eight died. Diabetic ketoacidosis or non-ketotic hyperosmolar syndrome, obesity and smoking were significant predictors of death.
Early diagnosis by means of CT and CT-guided percutaneous drainage (which is better than ultrasonography-guided drainage) or open drainage, along with antibiotic treatment, may be a reasonable alternative to nephrectomy for this high morbidity condition.
气肿性肾盂肾炎（EPN）患者的死亡率很高，长期以来对于最佳治疗方法一直存在争议。
1993年1月至2004年12月期间，我院共治疗了26例确诊为EPN的患者。从病历中获取历史、人口统计学和实验室数据进行分析。
患者的平均年龄为58.7±12.7岁。所有患者均患有糖尿病，女性多于男性（23:3）。临床表现无特异性。仅9/26例患者（36%）通过腹部平片确诊，13例（50%）超声检查准确，所有病例CT检查均能确诊。18例患者存活，其中包括所有5例行开放引流治疗的患者以及4例行经皮引流治疗患者中的3例（尽管其中1例后来需要进行肾切除术），8例死亡。糖尿病酮症酸中毒或非酮症高渗综合征、肥胖和吸烟是死亡的重要预测因素。
对于这种高发病率疾病，通过CT及CT引导下经皮引流（优于超声引导下引流）或开放引流并联合抗生素治疗进行早期诊断，可能是肾切除术的合理替代方案。
