Rosoff James S, Raman Jay D, Del Pizzo Joseph J
Department of Urology, New York-Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York 10021, USA.
Urology. 2006 Oct;68(4):711-4. doi: 10.1016/j.urology.2006.04.031.
To report the feasibility of the laparoscopic approach for management of xanthogranulomatous pyelonephritis (XGP).
From 2002 to 2005, 11 patients underwent laparoscopic (n = 7) or hand-assisted laparoscopic (n = 4) nephrectomy by a single surgeon for pathologically confirmed XGP. The preoperative presentation, operative details, postoperative recovery, and complications were recorded.
A total of 5 men and 6 women were included in this study, and the mean patient age was 51 years (range 28 to 78). All cases began with the laparoscopic approach (6 left and 5 right). Four cases were converted to the hand-assisted technique because of the difficulty in progression, but no case required conversion to open nephrectomy. The mean operative time was 157 minutes (range 101 to 201), with a mean estimated blood loss of 217 mL (range 50 to 440). No intraoperative complications occurred. The mean hospital duration was 2.4 days (range 1.5 to 4). Four patients had postoperative complications, including two with an ileus, one with a persistent fever requiring intravenous antibiotics, and one with a renal fossa abscess requiring percutaneous drainage. All specimens were pathologically confirmed to be XGP.
Laparoscopic nephrectomy for XGP is complicated and more technically demanding than the laparoscopic nephrectomy for noninfectious etiologies. Consideration should be made for using a hand port should the laparoscopic procedure fail to progress in a satisfactory manner. In experienced hands, the laparoscopic approach presents a reasonable surgical option for the treatment of XGP. For the novice laparoscopist, however, the open approach should remain the modality of choice.
报告腹腔镜手术治疗黄色肉芽肿性肾盂肾炎（XGP）的可行性。
2002年至2005年，11例经病理证实为XGP的患者由同一外科医生行腹腔镜肾切除术（7例）或手辅助腹腔镜肾切除术（4例）。记录术前表现、手术细节、术后恢复情况及并发症。
本研究共纳入5例男性和6例女性，患者平均年龄51岁（范围28至78岁）。所有病例均采用腹腔镜入路（左侧6例，右侧5例）。4例因手术进展困难转为手辅助技术，但无一例需要转为开放性肾切除术。平均手术时间为157分钟（范围101至201分钟），平均估计失血量为217毫升（范围50至440毫升）。术中无并发症发生。平均住院时间为2.4天（范围1.5至4天）。4例患者出现术后并发症，包括2例肠梗阻、1例持续发热需静脉使用抗生素、1例肾窝脓肿需经皮引流。所有标本经病理证实为XGP。
与非感染性病因的腹腔镜肾切除术相比，XGP的腹腔镜肾切除术更为复杂，技术要求更高。如果腹腔镜手术进展不顺利，应考虑使用手辅助端口。在经验丰富的医生手中，腹腔镜入路是治疗XGP的一种合理手术选择。然而，对于新手腹腔镜医生来说，开放手术仍应是首选方式。
