Babut J M, Coeurdacier P, Bawab F, Treguier C, Fremond B
Clinique Chirurgicale Infantile, C.H.R.U. Pontchaillou, Rennes, France.
Eur J Pediatr Surg. 1995 Aug;5(4):248-52. doi: 10.1055/s-2008-1066218.
We report two cases of urinary obstruction by fungal bezoars in full-term neonates who presented a uropathy detected antenatally. Early percutaneous urinary diversion was performed to relieve renal impairment secondary to a primary megaureter in the first case and to bilateral pelvi-ureteral obstruction in the second. Acute fungal obstruction occurred first on the side of the primary megaureter and then on the healthy side in the first patient. Symptoms of infection and impaired renal function led to a diagnosis of fungal bezoar. In the second patient the development of the bezoar was more insidious and occurred after surgical correction of the obstructive pelvi-ureteral junction on the left side. Candiduria was the first sign in both cases. Ultrasonography is the best method to visualize fungal masses within the collecting system. In most cases, percutaneous nephrostomy allows relief of the obstruction, sampling of urine for culture and irrigation with amphotericin B. However, additional surgical intervention may be necessary. Systemic antifungal treatment using mainly 5-flucytosine is also given.
我们报告了两例足月新生儿真菌粪石导致尿路梗阻的病例，这两名新生儿在产前均被检测出患有泌尿系统疾病。第一例因原发性巨输尿管导致肾功能损害，早期进行了经皮尿液改道以缓解症状；第二例因双侧肾盂输尿管梗阻进行了同样的操作。在第一例患者中，急性真菌梗阻首先发生在原发性巨输尿管一侧，随后出现在健康侧。感染症状和肾功能损害导致了真菌粪石的诊断。在第二例患者中，粪石的形成更为隐匿，发生在左侧梗阻性肾盂输尿管连接部手术矫正之后。两例患者的首个症状均为念珠菌尿。超声检查是观察集合系统内真菌团块的最佳方法。在大多数情况下，经皮肾造瘘术可缓解梗阻，采集尿液进行培养并用两性霉素B冲洗。然而，可能需要额外的手术干预。同时也会给予主要使用5-氟胞嘧啶的全身性抗真菌治疗。
