Eastham J, Ahlering T, Skinner E
Department of Urology, University of Southern California, Los Angeles.
Urology. 1994 Mar;43(3):295-9. doi: 10.1016/0090-4295(94)90069-8.
Xanthogranulomatous pyelonephritis (XGP) is an uncommon but well-characterized inflammatory process of the kidney. Few reports, however, have correlated preoperative radiographic features with findings at surgical exploration. We report our experience in the surgical management of XGP with emphasis on the use of computed tomography (CT) in the preoperative evaluation.
We retrospectively reviewed all medical records including radiographic materials of 27 patients with a pathologic diagnosis of XGP. In particular, preoperative CT features were analyzed to see if they correlated with surgical findings.
A CT scan was performed in 23 of the 27 patients. Of these 23 patients 20 (87%) were diagnosed with XGP based on the CT findings. CT accurately defined the extent of the perinephric inflammatory reaction, identifying 8 patients with muscular extension, 3 with splenic involvement, 1 with extension into the colon, and 5 with encasement of the great vessels. In no case did CT underestimate the involvement of adjacent tissues.
Although XGP is a rare disease, a careful preoperative evaluation can suggest its diagnosis. CT is particularly valuable in that it not only demonstrates characteristic renal findings, but also shows the extent of inflammation and extent into adjacent tissues. This will aid in surgical planning in choosing an approach that will provide adequate exposure and facilitate patient care.
黄色肉芽肿性肾盂肾炎（XGP）是一种罕见但特征明确的肾脏炎症性疾病。然而，很少有报告将术前影像学特征与手术探查结果相关联。我们报告我们在XGP手术治疗方面的经验，重点是计算机断层扫描（CT）在术前评估中的应用。
我们回顾性分析了27例经病理诊断为XGP患者的所有病历，包括影像学资料。特别分析术前CT特征，以观察其是否与手术结果相关。
27例患者中有23例行CT扫描。在这23例患者中，20例（87%）根据CT表现诊断为XGP。CT准确界定了肾周炎症反应的范围，发现8例炎症累及肌肉，3例累及脾脏，1例累及结肠，5例大血管被包绕。CT无一例低估相邻组织的受累情况。
尽管XGP是一种罕见疾病，但仔细的术前评估有助于诊断。CT尤其有价值，因为它不仅能显示肾脏的特征性表现，还能显示炎症范围及向相邻组织的累及情况。这将有助于手术规划，选择能提供充分暴露并便于患者护理的手术入路。
