摘要
目的探讨黄色肉芽肿性肾盂肾炎(XGP)的临床诊治特点。方法回顾性分析1981年5月至2017年12月收治的41例XGP患者的临床资料,其中宁夏银川市第二人民医院6例,上海交通大学医学院附属新华医院35例。男17例,女24例;年龄23~78岁,平均57岁。均为单侧病变,左侧19例,右侧22例。病程1周~12年,平均3.5年。临床表现:肉眼血尿7例(17.1%)、患侧腰腹部包块16例(39.0%)、腰部酸胀痛36例(87.8%)、发热26例(63.4%)和消瘦17例(41.5%)。实验室检查显示血白细胞增高28例(68.3%)、血色素降低24例(58.5%)、尿白细胞增多27例(65.9%)、尿培养阳性19例(19/34,55.9%)、尿泡沫细胞阳性3例(3/14,21.4%)、红细胞沉降率增快20例(48.8%)。35例行CT检查,其中25例诊断为XGP,主要表现为患肾弥漫性改变,肾影增大,伴有多个低密度病灶的弥漫分布;增强扫描时低密度病灶无明显强化,伴相应部位肾筋膜增厚、与腰大肌粘连或累及周围组织器官。20例行MRI检查,其中9例诊断为XGP,主要表现为患肾影增大,囊性病灶在T1加权像为中密度,T2加权像为高密度。34例行B超检查,21例诊断为XGP,表现为肾积水、实质弥漫病变、肾实质萎缩和局灶性低回声等。19例行静脉尿路造影(IVU)检查,7例诊断为XGP,主要表现为患侧肾内散在结石影或输尿管结石影、患肾不显影、肾盂肾盏受压或破坏。7例行肾动脉造影,4例诊断为XGP,主要表现为患肾血管变细、受压、拉长,病变区血管稀疏,无新生病理血管、无动静脉瘘等。根据影像学结果,本组中弥漫型33例,局限型8例。11例行肾穿刺活检,3例诊断为XGP。结果本组41例均行手术治疗,33例实质弥漫型病变者行肾切除术;8例局限型者中6例行肾部分切除术,2例术中发现肾周围粘连严重,病变边界不清而行肾切除术。术后病理检查,大体标本见患肾体积增大,肾剖面有多发、散在的黄色结节斑块。肾皮质萎缩,肾盏扩张。�
Objective To discuss the clinical diagnosis and treatment of xanthogranulomatous pyelonephritis (XGP). Methods Clinical data of 41 XGP patients admitted from May 1981 to December 2017 were retrospectively analyzed. There were 17 male cases and 24 female cases, aged from 23 to 78 years, with an average age of 57 years. All were unilateral lesions, including 19 cases on the left and 22 cases on the right. Disease duration ranged from 1 week to 12 years, with an average of 3.5 years. The clinical manifestations showed that 7 cases with gross hematuria (17.1%), 16 cases with palpable flank or abdominal mass (39.0%), 36 cases with flank pain (87.8%), 26 cases with acute or intermittent fever (63.4%) and 17 cases with weight loss (41.5%). Laboratory findings showed that 28 cases with leukocytosis (68.3%), 24 cases with anemia (58.5%), 27 cases with pyuria (65.9%), positive urine culture 19/34 (55.9%), positive urine lipid-laden macrophages 3/14(21.4%), and 20 cases with rapid erythrocyte sedimentation rate (48.8%). Imaging examination: among 35 patients who received CT examination, 25 were diagnosed as XGP, mainly presenting diffuse changes in the kidney with enlarged renal shadow, accompanied by diffusive distribution of multiple low-density lesions. There was no obvious enhancement in the low-density lesions on enhanced scan, accompanied by thickening of renal fascia, adhesion to psoas major muscle or involvement of surrounding tissues and organs. According to the imaging results, there were 33 cases of diffuse type and 8 cases of localized type in this group. Renal biopsy was performed 11 cases and 3 cases were diagnosed as XGP. Results All patients were treated with surgical procedure. 33 patients with diffuse type were performed nephrectomy. 6 of the 8 patients with localized type underwent partial nephrectomy successfully, and the other 2 patients underwent nephrectomy due to severe renal adhesion and unclear lesion boundaries. All postoperative pathologies suggested xanthogranulomatous pyelonephritis. Patients w
作者
卓涛
叶敏
张金伟
朱英坚
Zhuo Tao;Ye Min;Zhang Jinwei;Zhu Yingjian(Department of Urology, Yinchuan Second People’s Hospital, Yinchuan 750011, China;Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2019年第8期578-582,共5页
Chinese Journal of Urology
关键词
肾盂肾炎
黄肉芽肿性
诊断
治疗
手术
Pyelonepritis, xanthogranulomatous
Diagnosis
Treatment
Surgery
