Somani Bhaskar K, Nabi Ghulam, Thorpe Peter, Hussey Jeff, Cook Jonathan, N'Dow James
University of Aberdeen, Aberdeen, Scotland, United Kingdom.
J Urol. 2008 May;179(5):1844-9. doi: 10.1016/j.juro.2008.01.019. Epub 2008 Mar 19.
There is no current consensus on what constitutes the ideal management of emphysematous pyelonephritis. We review the current management strategies including the role of nephron preserving percutaneous drainage in the treatment of emphysematous pyelonephritis.
We searched MEDLINE, PubMed, EMBASE, CINAHL and the Cochrane Library from 1966 to 2006. Abstracts were reviewed including all types of studies from prospective randomized controlled studies to small retrospective series. All relevant English language articles reporting on at least 5 patients were reviewed.
Ten retrospective studies on 210 patients with emphysematous pyelonephritis met the inclusion criteria. There were 167 females and 43 males with a mean age of 57 years (range 24 to 83). Of the patients 96% had diabetes mellitus and 29% had urinary tract obstruction. The diagnostic accuracy of computerized tomography was 100%. Escherichia coli and Klebsiella were the most common causative agents. The mortality from medical management alone was 50%, medical management combined with emergency nephrectomy was 25% and medical management combined with percutaneous drainage was 13.5%. Mortality was significantly less in patients undergoing percutaneous drainage compared to other treatments (Pearson chi-square p <0.001). Of the patients who underwent medical treatment with percutaneous drainage a small number (15) underwent elective nephrectomy and mortality was 6.6% (1 of 15).
Percutaneous drainage should be part of the initial management strategy for emphysematous pyelonephritis. This strategy is associated with a lower mortality than medical management or emergency nephrectomy. Delayed elective nephrectomy may be required in some patients.
目前对于气肿性肾盂肾炎的理想治疗方案尚无共识。我们回顾了当前的治疗策略，包括保留肾单位的经皮引流在气肿性肾盂肾炎治疗中的作用。
我们检索了1966年至2006年期间的MEDLINE、PubMed、EMBASE、CINAHL和Cochrane图书馆。对摘要进行了回顾，包括从前瞻性随机对照研究到小型回顾性系列研究的所有类型研究。对所有报道至少5例患者的相关英文文章进行了回顾。
十项关于210名气肿性肾盂肾炎患者的回顾性研究符合纳入标准。其中女性167例，男性43例，平均年龄57岁（范围24至83岁）。患者中96%患有糖尿病，29%患有尿路梗阻。计算机断层扫描的诊断准确率为100%。大肠杆菌和克雷伯菌是最常见的病原体。单纯药物治疗的死亡率为50%，药物治疗联合急诊肾切除术为25%，药物治疗联合经皮引流为13.5%。与其他治疗相比，接受经皮引流治疗的患者死亡率显著降低（Pearson卡方检验p<0.001）。在接受经皮引流药物治疗的患者中少数（15例）接受了择期肾切除术，死亡率为6.6%（15例中的1例）
经皮引流应成为气肿性肾盂肾炎初始治疗策略之一部分。该策略与低于药物治疗或急诊肾切除术的死亡率相关。部分患者可能需要延迟择期肾切除术。
