黄色肉芽肿性肾盂肾炎诊断与治疗

目的探讨黄色肉芽肿性肾盂肾炎的诊断及治疗方法。方法对2002年～2010年收治的黄色肉芽肿性肾盂肾炎10例患者的临床资料进行回顾性分析,结合文献复习,就其临床表现、影像学特征、诊断及鉴别诊断、治疗等问题进行讨论。结果 9例患者术前误诊,1例患者经B超引导下肾穿刺活检确诊,所有病例均经病理确诊为黄色肉芽肿性肾盂肾炎,1例予以单纯抗感染治疗,症状消失,9例行手术治疗,其中3例行根治性肾切除术,4例行肾切除术,2例行肾部分切除术。术后效果良好,随访5例,至今无1例复发。结论黄色肉芽肿性肾盂肾炎临床表现复杂多样,缺乏特异性,极易误诊。B超引导下肾穿刺活检,是确诊的良好手段。抗感染及手术是治疗的主要手段。     

黄色肉芽肿性肾盂肾炎9例分析

目的：探讨黄色肉芽肿性肾盂肾炎的临床诊断及治疗方法。方法：9例均行手术治疗,6例行肾切除术,3例行肾根治切除术。结果：9例全部治愈,随访无复发。结论：黄色肉芽肿性肾盂肾炎术前诊断困难,CT检查较有诊断价值,穿刺活检可确诊。治疗可根据临床分期采用肾切除或肾部分切除,腹腔镜手术操作困难,中转率高。     

黄色肉芽肿性肾盂肾炎的诊断与治疗

目的探讨黄色肉芽肿性肾盂肾炎（XGP）的诊断和治疗方法。方法分析12例XGP临床特点。本组患者常见症状为腰痛、发热、消瘦、血尿。12例中7例尿细菌培养阳性。术前诊断XGP3例,术中快速冰冻切片诊断XGP2例。结果10例行肾切除术,2例行肾部分切除术。术后病理检查12例均为XGP。平均随访3.2年未见复发。结论XGP临床表现无特异性。CT扫描对弥漫型XGP诊断意义较大,局限型需与肾癌相鉴别,必要时穿刺活检或术中冰冻切片检查。治疗上应根据临床分期选择肾部分切除术或肾切除术,同时配合应用抗生素。     

黄色肉芽肿性肾盂肾炎的误诊原因分析

目的提高黄色肉芽肿性肾盂肾炎的诊治水平.方法总结18例黄色肉芽肿性肾盂肾炎患者的诊治资料.男5例,女13例.平均年龄47岁.左侧6例,右侧12例.术前误诊为肾结石伴积水4例,输尿管结石伴肾重度积水3例,肾结核3例,肾癌8例.结果18例患者术中快速冰冻切片7例,诊断为黄色肉芽肿性肾盂肾炎,另11例肾切除术后病理检查确诊.病理报告：病灶处有大量炎性细胞,胞质内有大量含类脂的泡沫细胞,核较小且一致,无核分裂及异形性.18例术后随访6～124个月,未见复发.结论黄色肉芽肿性肾盂肾炎术前诊断困难,尿液涂片有泡沫细胞、CT值为低密度值以及抗炎治疗无效等为本病的临床特点,综合分析临床资料,提高对此病的临床认识是避免误诊的关键.     

肾脏非肿瘤实性肿块诊治分析(附12例报告)

目的:提高肾脏非肿瘤实性肿块的诊治水平。方法:回顾12例的诊治过程,分析其临床表现、病理和影像学特点。结果:除肾炎性假瘤和肾血肿有可疑或明确的病史外,其余无明确病史;全部病例行B超、CT检查,1例肾血肿CT提示“血肿不能除外”其余均诊断肾癌或肾肿瘤。手术治疗7例,4例按肾癌行肾癌根治术,1例行肾切除术;2例行术中冷冻活检1例提示黄色肉芽肿性肾盂肾炎,1例提示肾炎性假瘤。5例未手术者观察随访1～4个月后B超复查包块均消失。结论:虽然B超、CT等影像学的检查对肾肿瘤有重要的诊断价值,但是临床医生不应过高评价这些影像检查的诊断学意义。提高诊断水平,术前影像学的复查,肾穿刺活检及术中行冷冻病理检查可减少误诊误治。     

黄色肉芽肿性胆囊炎误诊为胆囊癌十例分析

目的 分析黄色肉芽肿性胆囊炎（xanthogranulomatous cholecystitis,XGC）误诊为胆囊癌的原因.方法 分析我院1996-2005年间确诊为黄色肉芽肿性胆囊炎的33例的临床资料,其中10例在术前和术中误诊为胆囊癌.结果 10例患者中B超和CT均诊断为胆囊癌5例,慢性胆囊炎1例;B超诊断为胆囊癌而CT诊断为慢性胆囊炎2例;B超诊断为慢性胆囊炎而CT诊断为胆囊癌2例;术中均见有胆囊壁增厚,胆囊与肝、大网膜等周围组织粘连.3例行胆囊切除＋肝部分切除术,6例行胆囊切除＋肝部分切除术＋肝十二指肠韧带清扫术,1例行部分胆囊切除＋胆囊空肠吻合＋横结肠部分切除.术后病理为黄色肉芽肿性胆囊炎.结论 黄色肉芽肿性胆囊炎影像学表现和肉眼所见易误诊为胆囊癌.确诊需依赖病理检查.术中冰冻组织学检查有助于明确病变性质.     

黄色肉芽肿性肾盂肾炎的诊断与治疗(附8例报告)

目的　探讨黄色肉芽肿性肾盂肾炎 (XGP)的诊断及临床治疗方法。方法　总结 1995年至 2 0 0 2年收治的 8例XGP的临床表现、实验室检查结果、影像学特点及治疗方法。结果　CT扫描 8例 ,2例怀疑为XGP ;IVU及B超检查未做出特异性诊断提示。8例中行肾根治切除术 4例 ,肾切除 4例 ,全部获得治愈。结论　XGP缺乏特异性诊断方法 ,可根据临床及影像学表现做出初步诊断 ,必要时进行穿刺活检确诊。治疗上可根据临床分期、病变部位等采取肾切除术为主的治疗方式     

黄色肉芽肿性肾盂肾炎——附19例报告

目的 探讨黄色肉芽肿性肾盂肾炎（）0GP）的早期诊断和治疗。方法 回顾总结19例XGP的临床表现、实验室检查结果、影像学特点及不同治疗方法的疗效。结果 静脉尿路造影（IVU）和B超检查元特异性。CT检查11例，有4例诊断为XGP。经B超引导下穿刺活检3例，有2例确诊为XGP。尿找泡沫细胞阳性1例。19例均行手术治疗，其中肾部分切除术2例，肾切除术13例，肾根治性切除术4例。术后随访10个月～23年，未见本病复发。结论 常规CT或肾穿刺活检有助于本病的早期诊断。治疗上应根据临床分期选择肾部分切除术或肾切除术。     

局灶型黄色肉芽肿性肾盂肾炎的诊治

黄色肉芽肿性肾盂肾炎(xanthogranulomatous pyelonephritis,XGP)是一种少见的严重的肾实质感染性疾病,它分为局灶型和弥漫型两种.局灶型表现为肾实质内的肿瘤样软组织肿块,弥漫型表现为肾脏肿大,其内多个水样低密度区[1～3].既往对黄色肉芽肿性肾盂肾炎的治疗多行肾切除术或部分肾切除术[4,5].我们于1999年4月～2004年8月收治7例局灶型XGP患者,报告如下.     

黄色肉芽肿性胆囊炎的诊治分析

目的 本研究着重于探讨黄色肉芽肿性胆囊炎的诊断和治疗.方法 对本院2004年6月至2012年7月病理确诊为XGC的19例患者资料进行回顾性分析.结果 术前3例诊断为XGC,2例术前误诊为胆囊癌.5例行开腹手术,14例行经腹腔镜胆囊切除术（中转开腹4例）,腹腔镜与开腹手术组平均手术时间分别为87.3min及102.7min,但未有统计学意义（P＞0.05）.腹腔镜与开腹手术组术后平均住院天数分别为5.2天及9.4天,有显著差异（P=0.006）.结论 GC临床表现不典型,往往是难以术前诊断.病理检查是XGC诊断的关键,胆囊切除术是主要的治疗方法.     

黄色肉芽肿性肾盂肾炎(附30例报告)

目的 探讨黄色肉芽肿性肾盂肾炎垢早期诊断方法及治疗效果。方法 回顾性总结３０例ＤＸＧＰ临床表现、实验室检查结果、影像学特点及不同治疗方法的疗效。结果 ＩＶＵ及Ｂ超检查无特异性。ＣＴ扫描１９例,５例懔弥温型ＸＧＰ,３例经Ｂ超引导下穿刺活检而确诊,３０例ＸＧＰ中１例经抗炎治疗痊愈,２９例手术治疗,其中肾部分切除术２例,肾根治切除术１０例,肾切除术１７ 。结论 弥漫型ＸＧＰ可通过ＣＴ扫描而确立诊断,局灶     

Xanthogranulomatous pyelonephritis: Analysis of 18 cases

OBJECTIVE: To review and evaluate patients with a clinicopathological diagnosis of xanthogranulomatous pyelonephritis (XGP) with emphasis on the diagnostic methods and the effect of socioeconomic status on disease severity. METHODS: Data compiled from the previous history of the patients, clinical, laboratory, radioimaging findings, preoperative, operative, histopathological diagnosis and postoperative follow-up period were analysed. On the basis of presentation, XGP was classified as complicated and simple. RESULTS: There were 18 cases of XGP. The clinical characteristics included: calculi or obstruction in the urinary tract, and damage to the kidney, complication of urinary tract infection, anaemia, increased erythrocyte sedimentation rate and liver dysfunction. All patients had diffuse XGP. Associated pathological findings such as psoas abscess, nephrocutaneous fistula, renocolonic fistula and paranephric abscess were found in 33.3% of cases. Eleven of 14 patients (78.6%) who were evaluated by computed tomography (CT) had the correct diagnosis made prior to nephrectomy. Urine culture was positive in 88.9% of patients and Proteus mirabilis was the most common organism. CONCLUSION: Our experience with a small number of patients demonstrates that low socioeconomic status could be a risk factor in the development of complicated cases of XGP. CT is considered to be the best radiological test for correct preoperative diagnosis and evaluation of XGP. Nephrectomy and removal of all surrounding affected tissue proved to be curative for XGP.     

肾良性肿瘤和瘤样病变诊治分析(附49例报告)

目的　提高肾良性肿瘤和瘤样病变的诊治水平。　方法　肾良性肿瘤和瘤样病变 4 9例 ,均行B超和CT检查 ,14例行MRI检查 ,分析临床表现、病理和影像学特点。 2 1例术前未能确诊 ,按肾癌行肾切除术 ;2 8例行保留肾单位的肿瘤切除术。　结果　各种病变临床症状无特异性。血管平滑肌脂肪瘤CT和MRI表现含脂肪组织的影像学特点。彩超检测 2例肾动脉瘤和 2例动静脉瘘有特异性表现。其他良性病变无特异性影像学表现。行保肾手术的 2 8例患者随访 1～ 9年无复发 ,肾功能正常。　结论　B超、CT、MRI和彩超等影像学检查对肾良性肿瘤和病变有重要诊断价值。有依据的保留肾单位的肿瘤切除术和术中行冰冻病理检查可减少误诊误治。     

A clinical study of xanthogranulomatous pyelonephritis (XGP) with special emphasis on the magnetic resonance imaging]

Xanthogranulomatous pyelonephritis (XGP) is an uncommon form of granulomatous inflammation characterized by destruction and replacement of the renal parenchyma by masses of lipid-laden macrophages. We report the first case of the pyonephrotic type of XGP in which Magnetic resonance imaging (MRI) was used in Japan, and summarize the clinical characteristics of 163 cases with XGP in the Japanese literature for age, sex, laboratory data, preoperative diagnosis and operation. A 56-year-old female was admitted with left flank pain. Left nephrectomy was performed following diagnosis of XGP by computed tomography (CT) and MRI. Histopathological findings confirmed the diagnosis of XGP. Furthermore, we evaluated the MR images in XGP. MR images correlated well with the CT images showing an enlarged multiloculated kidney. The internal portion of the loculated areas were of intermediate intensity on T1-weighted images, and became very intense on the T2-weighted sequences, indicating a long T2. MRI appears to be of value in the investigation of renal mass lesions.     

肾钙乳症的诊断和治疗（附12例报告）

目的：探讨肾钙乳症的诊断和治疗方法.方法：回顾性分析1998～2009年收治的12例肾钙乳症患者的临床资料：12例均经X线腹部平片和超声检查,4例行CT检查;8例行肾钙乳囊腔切除术,1例行肾切除术,3例无症状者作随访观察.结果：术前确诊为肾钙乳症5例,拟诊为肾钙乳症3例,误诊为结石3例、结核1例.9例手术者术后恢复良好,3例仍在随访观察中.结论：本病的诊断主要依靠X线、B超及CT检查.对于病灶〈25mm无症状者,可随访观察;对于〈25 mm有症状者,应及早手术治疗.     

Laparoscopic nephrectomy for xanthogranulomatous pyelonephritis in the absence of kidney stones or clinical urinary infection

Here, we present a patient who underwent transperitoneal laparoscopic nephrectomy for a nonfunctional kidney on the left side, and who was found to have xanthogranulomatous pyelonephritis (XGP) on the subsequent histopathology examination. XGP is a severe, chronic infection of the renal parenchyma. Nephrectomy is the treatment of choice. Preoperative diagnosis of XGP can be challenging because the clinical presentation may vary. Our patient's loss of kidney function was due to a simple cortical kidney cyst that compressed the urinary collecting system. He presented only with mild flank pain and a poorly functioning kidney, and therefore XGP was not suspected before surgery. Because of the renal and perirenal inflammatory changes that commonly accompany XGP, the laparoscopic approach is difficult and is therefore rarely used. However, laparoscopic nephrectomy for XGP offers an easier recovery for the patient and therefore deserves further consideration as a method of treatment.     

Xanthogranulomatous pyelonephritis: a systematic review of treatment and mortality in more than 1000 cases

Objectives

To systematically review the current demographics, treatment and mortality rate associated with xanthogranulomatous pyelonephritis (XGP) and to test the hypothesis that the weighted pooled peri-operative mortality rate will be <10%.

Methods

Searches were performed of the Cochrane, Embase and Medline databases and the grey literature for studies published during the period 1 January 2000 to 30 August 2021. Eligible studies reported cohorts of ≥10 predominantly adult patients with XGP and described either average patient age or mortality rate.

Results

In total, 40 eligible studies were identified, representing 1139 patients with XGP. There were 18 deaths, with a weighted pooled peri-operative mortality rate of 1436 per 100 000 patients. The mean age was 49 years, 70% of patients were female and 28% had diabetes mellitus. The left kidney was more commonly affected (60%). Four patients had bilateral XGP, and all of whom survived. Renal or ureteric stones were present in 69% of patients, including 48% with staghorn calculi. Urine culture was positive in 59% of cases. Fistulae were present in 8%. Correct preoperative diagnosis occurred in only 45% of patients. Standard treatment continues to comprise a short cause of antibiotics and open radical (total) nephrectomy. Preoperative decompression occurred in 56% of patients. When considered at all, laparoscopic nephrectomy was performed in 34% of patients. Partial nephrectomy was conducted in 2% of patients.

Conclusions

Xanthogranulomatous pyelonephritis has a lower mortality rate than historically reported. A typical patient is a woman in her fifth or sixth decade of life with urolithiasis. While open radical nephrectomy remains the most common treatment method, laparoscopic, and to a lesser degree partial nephrectomy, are feasible in well selected patients.     

酷似肾囊肿的肾盏憩室7例临床分析

目的 提高对临床表现酷似肾囊肿的肾盏憩室的认识,探讨其诊治方法.方法 报告7例经本院收治的肾盏憩室患者的临床资料,回顾性分析其临床特征及影像学表现.7例患者以腰部胀痛为主要表现者2例,5例无明显症状.术前超声检查均诊断为肾脏囊肿,2例患者静脉肾盂造影检查怀疑肾盏憩室,5例行增强CT并延迟扫描后确诊为肾盏憩室.分析所有患者临床资料并检索Pubmed和CBM数据库,对该疾病相关文献进行复习.结果 1例患者行保守治疗,1例按单纯囊肿行去顶手术后出现漏尿,后行肾部分切除术.5例成功行腹腔镜肾盏憩室切除术,术前放置输尿管导管并于术中通过导管注射美蓝帮助确定憩室开口.术后随访6～24个月,未发现憩室复发.结论 肾盏憩室临床上少见,容易误诊.静脉肾盂造影及增强CT扫描对诊断该病有较大帮助,特别是CT延迟扫描.腹腔镜肾盏憩室切除术治疗该病安全有效.