Siegel J F, Smith A, Moldwin R
Long Island Jewish Medical Center, New Hyde Park, New York, USA.
J Urol. 1996 Jan;155(1):52-5.
We critically evaluated the most appropriate management of renal abscesses, and identified the set of patients that most benefits from conservative treatment.
We retrospectively reviewed charts regarding discharge diagnoses, radiological studies, pathological specimens, epidemiology factors and outcomes. Statistical analysis was performed using loglinear and covariant analysis.
Nine years of experience (1984 to 1993) at 2 affiliated hospitals (1 public and 1 private) were reviewed. A total of 52 patients with renal abscesses was identified with a followup rate of 98%. In immunocompetent patients 100% of small abscesses (less than 3 cm.) managed by antibiotics and observation alone resolved. Of medium abscesses (3 to 5 cm.) treated with percutaneous abscess drainage alone 92% resolved. Large abscesses (greater than 5 cm.) often required more than 1 percutaneous drainage procedure (33%) or adjunct open surgical intervention (37%). Statistical analysis revealed that no single treatment modality yielded a superior resolution rate or shorter hospitalization for abscesses stratified by size, patient age or treatment instituted early (1984 to 1993) or late (1992 and 1993) in the study period.
Our series suggests that percutaneous drainage is as effective as open surgery for large and medium renal abscesses. Small abscesses may be effectively treated with a course of intravenous antibiotic therapy. A treatment algorithm is reported.
我们严格评估了肾脓肿最恰当的治疗方法，并确定了最能从保守治疗中获益的患者群体。
我们回顾性分析了有关出院诊断、放射学检查、病理标本、流行病学因素及治疗结果的图表。采用对数线性分析和协变量分析进行统计分析。
回顾了两所附属医院（1所公立和1所私立）9年（1984年至1993年）的经验。共确定了52例肾脓肿患者，随访率为98%。在免疫功能正常的患者中，仅通过抗生素治疗和观察处理的小脓肿（小于3厘米）100%消退。仅采用经皮脓肿引流治疗的中等大小脓肿（3至5厘米）92%消退。大脓肿（大于5厘米）通常需要不止1次经皮引流手术（33%）或辅助开放性手术干预（37%）。统计分析显示，在研究期间，对于按大小、患者年龄或治疗时间（1984年至1993年为早期，1992年和1993年为晚期）分层的脓肿，没有单一的治疗方式能产生更高的消退率或更短的住院时间。
我们的系列研究表明，对于大中型肾脓肿，经皮引流与开放性手术同样有效。小脓肿可通过静脉抗生素治疗疗程有效治疗。报告了一种治疗方案。
