Wippermann C F, Schofer O, Beetz R, Schumacher R, Schweden F, Riedmiller H, Büttner J
University Children's Hospital, Mainz, Federal Republic of Germany.
Pediatr Infect Dis J. 1991 Jun;10(6):446-50. doi: 10.1097/00006454-199106000-00006.
During the past decade new techniques such as computed tomography (CT) and ultrasonography have been reported to have changed the diagnostic investigation and treatment of renal abscess in adults. To evaluate whether similar changes have taken place in the pediatric age group, a retrospective study of all patients seen between 1979 and 1989 was performed. Seven patients, 0.8 to 14 (mean, 9) years old, with renal abscesses in eight kidneys were identified. Ultrasound and computed tomography proved to be the most valuable diagnostic tools, revealing the diagnosis by showing a hypoechoic or hypodense mass. All patients had an initial trial of intensive antibiotic treatment, which led to resolution of the abscesses in two of the eight kidneys. In all other cases the abscesses were additionally drained, which was done surgically in two and by ultrasonography- or CT-guided percutaneous drainage in four patients. Abscess cultures grew Staphylococcus aureus (three), Escherichia coli (one) and Salmonella Group B (one) and were sterile in one case. Drainage was unsuccessful in only one patient, who subsequently underwent nephrectomy for uncontrolled infection of a diffusely damaged kidney. We conclude that the diagnosis of renal abscesses is greatly facilitated by ultrasonography and CT and that most patients can be cured without operation by antibiotics and, if necessary, by additional percutaneous drainage.
在过去十年中，据报道，诸如计算机断层扫描（CT）和超声检查等新技术已经改变了成人肾脓肿的诊断检查和治疗方法。为了评估在儿童年龄组中是否发生了类似的变化，我们对1979年至1989年间诊治的所有患者进行了一项回顾性研究。我们确定了7例年龄在0.8至14岁（平均9岁）之间、患有肾脓肿的患者，累及8个肾脏。超声检查和计算机断层扫描被证明是最有价值的诊断工具，通过显示低回声或低密度肿块来揭示诊断。所有患者都首先接受了强化抗生素治疗试验，其中8个肾脏中的2个脓肿通过该治疗得以消退。在所有其他病例中，脓肿均进行了额外引流，其中2例通过手术引流，4例通过超声或CT引导下经皮引流。脓肿培养结果显示，金黄色葡萄球菌（3例）、大肠杆菌（1例）和B组沙门氏菌（1例）生长，1例培养结果无菌。仅1例患者引流失败，该患者随后因弥漫性受损肾脏的感染无法控制而接受了肾切除术。我们得出结论，超声检查和CT极大地促进了肾脓肿的诊断，并且大多数患者无需手术，通过抗生素治疗以及必要时的经皮引流即可治愈。
