Bell D A, Rose S C, Starr N K, Jaffe R B, Miller F J
Department of Radiology, University of Utah School of Medicine, Salt Lake City.
J Vasc Interv Radiol. 1993 Mar-Apr;4(2):311-5. doi: 10.1016/s1051-0443(93)71866-7.
Percutaneous nephrostomy has proved to be an important modality in the nonoperative treatment of bacterial pyonephrosis. The role of this technique in the management of fungal pyonephrosis continues to evolve. The authors retrospectively reviewed their experience with percutaneous nephrostomy in the management of fungal pyonephrosis.
Seven patients, two neonates and five adults, were identified with proved fungal infections. Eleven percutaneous nephrostomy tubes were placed, all with use of the Seldinger technique.
Percutaneous nephrostomy allowed (a) prompt microbiologic diagnosis of fungal infection (Candida albicans in six patients, Torulopsis glabrata in one); (b) urinary diversion with subsequent improvement in renal function, enabling systemic administration of potentially toxic antifungal drugs 5-fluorocytosine and amphotericin B (four patients); (c) local irrigation with amphotericin B (four patients), (d) guidewire fragmentation of fungus balls (two patients); and (e) introduction of a Simpson atherectomy device to obtain biopsy specimens from an obstructing ureteral polypoid lesion (one patient). The funguria was successfully eradicated in six patients, one of whom died on the 39th hospital day of a pulmonary embolus and another of whom died of extensive small bowel infarction during hospitalization. The one patient whose outcome of antifungal treatment remains unknown died at home with a functioning percutaneous nephrostomy 23 days after the procedure.
Percutaneous nephrostomy may play a role in the non-operative management of fungal urinary tract infection.
经皮肾造瘘术已被证明是细菌性肾盂积脓非手术治疗中的一项重要手段。该技术在真菌性肾盂积脓治疗中的作用仍在不断演变。作者回顾性分析了他们应用经皮肾造瘘术治疗真菌性肾盂积脓的经验。
确定7例患者患有确诊的真菌感染，其中2例为新生儿，5例为成年人。共放置了11根经皮肾造瘘管，均采用Seldinger技术。
经皮肾造瘘术能够（a）迅速对真菌感染进行微生物学诊断（6例为白色念珠菌，1例为光滑假丝酵母菌）；（b）进行尿液引流，随后肾功能得到改善，从而能够全身应用潜在毒性的抗真菌药物5-氟胞嘧啶和两性霉素B（4例患者）；（c）用两性霉素B进行局部冲洗（4例患者）；（d）用导丝破碎真菌球（2例患者）；以及（e）引入Simpson旋切装置以获取阻塞性输尿管息肉样病变的活检标本（1例患者）。6例患者的真菌尿被成功根除，其中1例在住院第39天死于肺栓塞，另1例在住院期间死于广泛的小肠梗死。1例抗真菌治疗结果未知的患者在术后23天在家中死亡，当时经皮肾造瘘仍在发挥作用。
经皮肾造瘘术可能在真菌性尿路感染的非手术治疗中发挥作用。
