摘要
目的探讨肾脓肿和肾肿瘤的鉴别诊断要点。方法回顾性分析肾脓肿误诊为肾肿瘤17例的临床资料。结果 17例有腰部疼痛史5例,发热史2例,12例见肉眼血尿;单侧单个发病;患肾侧腰痛5例,发热及肾区不适胀痛各2例,寒战、尿频尿急、膀胱刺激征及腰大肌刺激征阳性各1例;查血白细胞升高14例[(11.2~12.5)×10^9/L],中性粒细胞升高13例(0.732~0.843),尿常规示12例红细胞(+^++++);影像学检查发现肾实质占位性病变。均初步诊断为肾肿瘤,误诊时间1~3个月。1例术前加行超声引导下肿物穿刺细胞学检查确诊为肾脓肿,给予抗感染治疗后肿物消失;16例行手术治疗,经术中及术后病理检查修正诊断为肾脓肿,给予置管引流术及敏感抗生素抗感染治疗后肿物消失。结论当临床遇及影像学检查发现肾实质占位性病变患者,无论是否伴有全身感染症状、影像学表现是否类似肾肿瘤,均应考虑到肾脓肿可能;全面分析临床资料,及时行必要的医技检查,仔细鉴别诊断,必要时行CT引导下肾穿刺细胞学检查,以减少误诊误治。
Objective To explore the key points in differential diagnosis between renal abscess and renal tumor. Methods The clinical data of 17 cases of renal abscess misdiagnosed as renal tumor was analyzed retrospectively. Results Of 17 cases, there were 5 cases with a history of lumbar pain, 2 cases with a history of fever, and 12 cases with gross hematuria. Single unilateral kidney was affected. In addition, there were 5 cases with lower back pain on the affected side of kidneys, 2 cases with fever and distending pain in the renal region respectively, 1 case with rigor, frequent and urgent urination, bladder irritation and psoas muscle irritation sign respectively, 14 cases [(11.2-12.5)×10^9/L] with leukocytosis, and 13 cases(0.732-0.843) with elevated neutrophils. Urine routine examination revealed red blood cells(+-+++++) in 12 cases, and the imaging examination showed the space-occupying lesions in renal parenchyma. All of them were initially diagnosed as renal tumors, and the duration of misdiagnosis was 1-3 months. One case was diagnosed with renal abscess by preoperative ultrasound-guided puncture cytology, and the abscess disappeared after anti-infection treatment. In 16 cases, surgical treatment was planned, and the renal abscess was diagnosed by intraoperative and postoperative pathological examination. After drainage and antibiotic-sensitive anti-infective therapy, the masses disappeared. Conclusion The possibility of renal abscess should be considered in patients with space-occupying lesions in renal parenchyma, whether they are accompanied by systemic infection symptoms or similar renal tumors based on imaging examination in clinical practice. Comprehensive analysis of clinical data, timely and necessary medical examination, careful differential diagnosis, and CT-guided cytology or surgical pathology examination if necessary are needed to reduce misdiagnosis and misdiagnosis.
作者
任大勇
姜林
刘敏
REN Da-yong;JIANG Lin;LIU Min(Department of Urology Surgery,the People's Hospital of Fengrun District,Tangshan,Hebei 064000,China;Department of Obstetrics and Gynecology,the People's Hospital of Zunhua,Zunhua,Hebei 064200,China)
出处
《临床误诊误治》
2020年第7期11-14,共4页
Clinical Misdiagnosis & Mistherapy
基金
河北省医学科学研究重点课题计划项目(20181420)。
关键词
肾脓肿
误诊
肾肿瘤
病理检查
诊断
Kidney abscess
Misdiagnosis
Kidney neoplasms
Pathological examination
Diagnosis
