Kapoor Rakesh, Vijjan Vivek, Singh Kamaljeet, Goyal Rajiv, Mandhani Anil, Dubey Deepak, Srivastava Aneesh, Kumar Anant
Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Urology. 2006 Nov;68(5):952-5. doi: 10.1016/j.urology.2006.07.009.
To report our experience with laparoscopic nephrectomy in patients with xanthogranulomatous pyelonephritis (XGP) and compare it with the open approach. XGP is an atypical and severe form of chronic renal infection. Open nephrectomy has been the procedure of choice for XGP. The laparoscopic approach has been used in cases of XGP but with increased complications and operative time.
A retrospective analysis of all the patients who underwent laparoscopic nephrectomy with a pathologic diagnosis of XGP from January 2001 to August 2005 was done. The demographic profile and data on the operative time, operative technique, blood loss, and complications were obtained.
In all, 25 patients underwent nephrectomy with a pathologic diagnosis of XGP, 10 laparoscopically and 15 by the open approach. Laparoscopic nephrectomy for XGP was successful in 80% of the cases. The dissection of the kidney was comparatively difficult in all cases because of dense adhesions in the perirenal region and required modification of the technique. The incidence of major complications was 20% and 10% in the open and laparoscopic groups, respectively. The mean hospital stay in the laparoscopic group was 3.8 days, significantly less than that for the open nephrectomy group (8.2 days). The mean operative time in the laparoscopic group was 3.8 hours compared with 2.5 hours in the open group.
Laparoscopy can be successfully performed in patients with a pathologic diagnosis of XGP. Although a longer operative time is required because of perinephric adhesions, the postoperative recovery is faster and cosmesis superior compared with the open approach. Modifications in the standard laparoscopic technique can be made to complete the procedure successfully and safely.
报告我们对黄色肉芽肿性肾盂肾炎(XGP)患者行腹腔镜肾切除术的经验,并与开放手术方法进行比较。XGP是一种非典型的严重慢性肾脏感染形式。开放肾切除术一直是XGP的首选手术方式。腹腔镜手术已应用于XGP病例,但并发症增多且手术时间延长。
对2001年1月至2005年8月间接受腹腔镜肾切除术且病理诊断为XGP的所有患者进行回顾性分析。获取患者的人口统计学资料以及手术时间、手术技术、失血量和并发症等数据。
共有25例患者接受了病理诊断为XGP的肾切除术,其中10例行腹腔镜手术,15例行开放手术。XGP腹腔镜肾切除术80%成功。由于肾周区域粘连紧密,所有病例中肾脏的游离相对困难,需要改进技术。开放组和腹腔镜组的主要并发症发生率分别为20%和10%。腹腔镜组的平均住院时间为3.8天,明显短于开放肾切除术组(8.2天)。腹腔镜组的平均手术时间为3.8小时,而开放组为2.5小时。
病理诊断为XGP的患者可以成功进行腹腔镜手术。尽管由于肾周粘连需要更长的手术时间,但与开放手术相比,术后恢复更快且美容效果更好。可对标准腹腔镜技术进行改进以成功、安全地完成手术。