膿腎症における超音波断層法および経皮的腎造瘻術の臨床的検討

Abstract

1)超音波断層法で16例全例に腎盂腎杯の拡張を認めたが, debrisやgasは認められなかった。腎盂腎杯内部のエコーレベルの検討では, 低エコーは2例, 無エコーは14例であった。2)臨床症状および超音波断層法での腎盂腎杯の拡張像から14例は膿腎症と診断しえた。全例とも腎盂穿刺により確定診断した。3)経皮的腎造瘻および抗菌療法により臨床状態は全例で改善した。腎瘻造設前に6日間以上の発熱を認めた5例中3例が敗血症を合併しており, 4例では腎瘻造設後も発熱が3日間以上持続した。4)経皮的腎造瘻により患側腎機能の回復がみられた11腎はすべて通過障害の原因に応じた治療により保存しえた

Sonography and percutaneous nephrostomy (PNS) were performed on 16 patients with pyonephrosis and the following results were obtained. Sonography revealed a dilated collecting system in all cases within which, however, neither debris nor gas was observed in any case, the pelvocaliceal system appeared hypoechoic in 2 cases and anechoic in 14 cases. From the clinical symptoms and the dilated collecting system demonstrated by sonography, pyonephrosis was diagnosed in 14 cases. The purulent fluid aspirated from the collecting system confirmed the diagnosis in all cases. The clinical condition was stabilized by PNS and antibacterial therapy in all cases. However, in 5 of the patients with pyrexia for more than 6 days before PNS, sepsis developed in 3 cases and pyrexia continued for more than 3 days after the treatment in 4 cases. The affected 11 kidneys showing recovery of renal function following PNS were all salvaged by elective surgery. These findings suggest that prompt diagnosis by needle aspiration is necessary, even in the absence of any sonographically characteristic findings, whenever pyonephrosis is suspected. Our experience suggests that PNS is a useful therapeutic procedure for pyonephrosis.