切换至 "中华医学电子期刊资源库"

中华腔镜泌尿外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (06) : 644 -647. doi: 10.3877/cma.j.issn.1674-3253.2024.06.018

所属专题: 经典病例

病例报告

气肿性肾盂肾炎、气肿性膀胱炎并脓毒性休克一例报道并文献复习
石海波1, 赵旭东2, 王聪1, 曲巍3,()   
  1. 1.435002 湖北,黄石市第二医院泌尿外科
    2.430014 湖北,武汉市江岸区谌家矶街卫生服务中心
    3.430000 武汉,湖北省中西医结合医院泌尿外科
  • 收稿日期:2023-06-25 出版日期:2024-12-01
  • 通信作者: 曲巍

Emphysematous pyelonephritis,emphysematous cystitis complicated with septic shock: a case report and literature review

Haibo Shi1, Xudong Zhao2, Cong Wang1, Wei Qu3,()   

  1. 1.Department of Urology,the Second Hospital of Huangshi,Hubei,435002,China
    2.Chenjiaji Street Health Service Center,Jiang 'an District,Wuhan 430014,China
    3.Department of Urology,Hubei Hospital of Integrated Traditional Chinese and Western Medicine,Wuhan 430000,China
  • Received:2023-06-25 Published:2024-12-01
  • Corresponding author: Wei Qu
引用本文:

石海波, 赵旭东, 王聪, 曲巍. 气肿性肾盂肾炎、气肿性膀胱炎并脓毒性休克一例报道并文献复习[J]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 644-647.

Haibo Shi, Xudong Zhao, Cong Wang, Wei Qu. Emphysematous pyelonephritis,emphysematous cystitis complicated with septic shock: a case report and literature review[J]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(06): 644-647.

气肿性肾盂肾炎是一种罕见的以肾实质广泛坏死伴肾实质内及肾周组织气体聚积为特征的肾实质感染性疾病。气肿性膀胱炎以膀胱壁内及周围存在气体为特征,多伴发于气肿性肾盂肾炎,更为罕见。本文报告一例气肿性肾盂肾炎合并气肿性膀胱炎的女性病例,尽管存在脓毒性休克、急性肾功能不全、低钠血症及血小板减少等预测保守治疗失败的危险因素,我们通过经皮穿刺引流结合内科综合治疗的保守方法,得以让患者保全肾脏并治愈出院。结合文献,我们讨论这一类疾病的临床表现、发病机制和治疗原则。

Emphysematous pyelonephritis (EPN) is a rare infectious disease of the renal parenchyma characterized by extensive necrosis of the renal parenchyma with gas accumulation in the renal parenchyma and perirenal tissues. Emphysematous cystitis is characterized by the presence of gas in and around the bladder wall,which is more rare and often associated with emphysematous pyelonephritis. We report a case of emphysematous pyelonephritis and emphysematous cystitis in a female patient. Despite the presence of septic shock,acute renal insufficiency,hyponatremia,and thrombocytopenia,the patient was cured and discharged after conservative treatment with percutaneous puncture drainage combined with medical treatment. Combined with the literature,we discuss the clinical manifestations,pathogenesis and treatment principles of this type of disease.

图1 气肿性肾盂肾炎合并气肿性膀胱癌患者腹盆部CT平扫
图2 患者穿刺引流抗感染后泌尿系CT平扫 注:图1示患者治疗前左肾实质内大量积气(红色箭头示),肾周少量积气(图1b白色箭头示);膀胱内大量积气(图1c白色箭头示);图2示患者治疗后50余天左侧肾实质内仍有少量积气(白色箭头示),膀胱内留置输尿管支架管(红色箭头示),积气完全吸收
[1]
Misgar RA,Mubarik I,Wani AI,et al. Emphysematous pyelonephritis: a 10-year experience with 26 cases[J]. Indian J Endocrinol Metab,2016,20(4): 475-480.
[2]
Ranjan SK,Navriya SC,Kumar S,et al. Emphysematous cystitis:a case report and literature review of 113 cases[J]. Urol Ann,2021,13(3): 312-315.
[3]
李艳秀,曹权. 脓毒症血管活性药物的选择[J]. 江苏大学学报(医学版),2023,33(2): 107-111.Li YX,Cao Q. Selection of vasoactive drugs for sepsis[J]. J Jiangsu Univ Med Ed,2023,33(2): 107-111.
[4]
Desai R,Batura D. A systematic review and meta-analysis of risk factors and treatment choices in emphysematous pyelonephritis[J].Int Urol Nephrol,2022,54(4): 717-736.
[5]
Nikitha N,Satpathy PK. Study of infections in type 2 diabetes mellitus[J]. J Assoc Physicians India,2022,70(4): 11-12.
[6]
Kapoor R,Muruganandham K,Gulia AK,et al. Predictive factors for mortality and need for nephrectomy in patients with emphysematous pyelonephritis[J]. BJU Int,2010,105(7): 986-989.
[7]
Newcomer JB,Myers CB,Chacon E,et al. Percutaneous drainage for non-operative management of emphysematous pyelonephritis:clinical characteristics and predictors of success[J]. J Clin Imaging Sci,2022,15: 59.
[8]
Singh U,Sankhwar SN,Kumar M. Emphysematous pyelonephritis with scrotal extension: an unusual case presentation[J]. Cureus,2023,15(9): e45065.
[9]
Huang JJ,Tseng CC. Emphysematous pyelonephritis:clinicoradiological classification,management,prognosis,and pathogenesis[J]. Arch Intern Med,2000,160(6): 797-805.
[10]
Koch GE,Johnsen NV. The diagnosis and management of lifethreatening urologic infections[J]. Urology,2021,156: 6-15.
[11]
Chaudhari P,Sawant R,Bordoloi M,et al. Non-albicans candida infection as a rare cause of emphysematous pyelonephritis in an uncontrolled diabetic patient: a case report[J]. Cureus,2024,16(3):e57036.
[12]
Villasuso-Alcocer V,Flores-Tapia JP,Perez-Garfias F,et al. Serratia fonticola and its role as a single pathogen causing emphysematous pyelonephritis in a non-diabetic patient: a case report[J]. World J Clin Cases,2022,10(29): 10600-10605.
[13]
Ideguchi S,Yamamoto K,Ikeda A,et al. A case of bilateral emphysematous pyelonephritis caused by Candida albicans[J]. J Infect Chemother,2019,25(4): 302-306.
[14]
Batirel A,Regmi SK,Singh P,et al. Urological infections in the developing world: an increasing problem in developed countries[J].World J Urol,2020,38(11): 2681-2691.
[15]
Wu SY,Yang SS,Chang SJ,et al. Emphysematous pyelonephritis:classification,management,and prognosis[J]. Tzu Chi Med J,2022,34(3): 297-302.
[16]
Bhat SK,Srivastava A,Ansari NA,et al. Emphysematous pyelonephritis in type 2 diabetes - clinical profile and management[J].Saudi J Kidney Dis Transpl,2021,32(6): 1646-1654.
[17]
Li S,Wang J,Hu J,et al. Emphysematous pyelonephritis and cystitis:a case report and literature review[J]. J Int Med Res,2018,46(7):2954-2960.
[18]
Huang JJ,Tseng CC. Emphysematous pyelonephritis:clinicoradiological classification,management,prognosis,and pathogenesis[J]. Arch Intern Med,2000,160(6): 797-805.
[19]
Lu YC,Chiang BJ,Pong YH,et al. Emphysematous pyelonephritis:clinical characteristics and prognostic factors[J]. Int J Urol,2014,21(3): 277-282.
[20]
Gite VA,Shaw V,Agrawal M,et al. Minimally invasive techniques as a first line approach in the management of emphysematous pyelonephritis - a single centre experience[J]. J Postgrad Med,2021,67(3): 146-153.
[21]
Misgar RA,Mubarik I,Wani AI,et al. Emphysematous pyelonephritis: a 10-year experience with 26 cases[J]. Indian J Endocrinol Metab,2016,20(4): 475-480.
[22]
Hinkamp CA,Keshvani N. Emphasising classification in emphysematous pyelonephritis[J]. Lancet,2020,395(10230): 1145.
[23]
Kone K,Mallikarjun NT,Rams MDRKK. Mortality in emphysematous pyelonephritis: can we reduce it further by using a protocol-based treatment? The results of a prospective study[J]. Urol Ann,2022,14(1): 73-80.
[24]
安恒庆,陈兴发,姜华,等. 上尿路疾病经皮穿刺途径诊疗安全共识[J]. 现代泌尿外科杂志,2021,26(2): 107-111.An HQ,Chen XF,Jiang H,et al. Safety consensus on diagnosis and treatment of upper urinary tract diseases by percutaneous puncture[J].J Mod Urol,2021,26(2): 107-111.
[25]
Somani BK,Nabi G,Thorpe P,et al. Is percutaneous drainage the new gold standard in the management of emphysematous pyelonephritis? Evidence from a systematic review[J]. J Urol,2008,179(5): 1844-1849.
[1] 郝鑫, 贾健, 任雨昊, 成凯, 王小虎. 膝关节骨关节炎的运动学疗法[J]. 中华关节外科杂志(电子版), 2024, 18(02): 264-270.
[2] 中华医学会骨科学分会关节外科学组, 解放军总医院第四医学中心骨科医学部, 国家骨科与运动康复临床医学研究中心. 中国膝骨关节炎非手术治疗专家共识(2023年版)[J]. 中华关节外科杂志(电子版), 2024, 18(02): 151-159.
[3] 李佳丽, 吴杨, 张莉, 夏斌, 何洋, 陈忠, 唐军, 母得志. 新生儿消化道穿孔患儿的临床特点及治疗结局[J]. 中华妇幼临床医学杂志(电子版), 2022, 18(06): 703-711.
[4] 胡金科, 钟文. 妊娠期输尿管结石的处理与转归[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(04): 377-381.
[5] 杨仁豪, 庄澄宇, 王蕾. Rockwood III型肩锁关节脱位的治疗研究进展[J]. 中华肩肘外科电子杂志, 2024, 12(01): 88-93.
[6] 张涛, 崔进, 周启荣, 陈晓, 苏佳灿. 肩锁关节脱位的治疗进展[J]. 中华肩肘外科电子杂志, 2023, 11(01): 77-82.
[7] 张清, 向明, 李一平, 陈杭, 胡晓川, 杨金松. 肩袖损伤保守治疗失败的危险因素分析[J]. 中华肩肘外科电子杂志, 2022, 10(02): 129-134.
[8] 何国文, 高大伟, 陈亮, 胡栢均. 保守治疗与锁骨钩钢板内固定手术治疗Rockwood Ⅲ型肩锁关节脱位的中长期疗效对比研究[J]. 中华肩肘外科电子杂志, 2022, 10(02): 110-114.
[9] 王龑懋, 陆晟迪, 沈龙祥, 丁坚. MasonⅠ型及Ⅱ型桡骨头骨折保守治疗失败病例分析[J]. 中华肩肘外科电子杂志, 2022, 10(01): 65-73.
[10] 毛进鹏, 陶治鹤, 刘琦, 王勇, 周明安, 陈劲松, 田少斌. 保守治疗大量创伤性硬膜外血肿的体会(附10例报告)[J]. 中华神经创伤外科电子杂志, 2024, 10(03): 164-168.
[11] 赖丽, 尧小龙, 李俊. 烟雾病合并血流相关性动脉瘤二例报道并文献复习[J]. 中华神经创伤外科电子杂志, 2024, 10(02): 122-125.
[12] 聂玉金, 曹培成. 创伤性颅脑损伤患者保守治疗发生脑积水的危险因素分析[J]. 中华神经创伤外科电子杂志, 2023, 09(06): 355-359.
[13] 吕鹏飞, 裴征, 张清华, 刘家帮. 老年桡骨远端关节内骨折保守与掌侧锁定钢板手术治疗的疗效比较[J]. 中华临床医师杂志(电子版), 2022, 16(06): 487-492.
[14] 郭志荣, 马京梅. 胎盘植入性疾病的风险评估和治疗策略[J]. 中华产科急救电子杂志, 2023, 12(03): 151-154.
[15] 刘虎, 任振, 韦笑韩, 潘晨, 吴立胜. 胃食管反流伴食管运动障碍的诊疗进展[J]. 中华胃食管反流病电子杂志, 2024, 11(03): 153-158.
阅读次数
全文


摘要