Abstract：
BACKGROUND: Xanthogranulomatous pyelonephritis (XGPN) is a rare form of chronic renal inflammation, caused by long-term obstruction of the urinary tract. Pyonephrosis is a severe suppurative complication of acute obstructive pyelonephritis. Although minimally invasive approaches have many advantages, the safe dissection of the kidney may not be always achievable.
METHODS: We reviewed 27 cases diagnosed with either XGPN or pyonephrosis, who underwent laparoscopic total nephrectomy between October 2016 and March 2022 in our department. All interventions were performed using the Karl Storz 3D laparoscopic system. The surgical approach was standard transperitoneal nephrectomy for the majority of XGPN, while pyonephrosis cases were carried out in a retroperitoneally. All procedures were performed or supervised by the same surgeon.
RESULTS: The mean operative time was 269.85 minutes (range 145-360). The mean hemoglobin drop after surgery was 1.41 g/dl (range 0.3-2.3 g/dl). Difficult dissection was encountered in 13 cases (48.14%). Nine out of 13 interventions were carried out in a complete intracorporeal fashion, while conversion to open surgery was needed in 4 cases. Vascular complications involving the major blood vessels comprised of one case of inferior vena cava (IVC) tear. Digestive tract-related complications comprised two fistulas of the descending colon and one peritoneal breach. Multiorgan resection was performed in 6 cases.
CONCLUSIONS: Total nephrectomy in cases of XGPN and pyonephrosis is a challenging procedure. The laparoscopic approach is feasible, as most complications are resolved intracorporeally. However, it may remain reserved for large-volume centers with experienced surgeons.
METHODS: We reviewed 27 cases diagnosed with either XGPN or pyonephrosis, who underwent laparoscopic total nephrectomy between October 2016 and March 2022 in our department. All interventions were performed using the Karl Storz 3D laparoscopic system. The surgical approach was standard transperitoneal nephrectomy for the majority of XGPN, while pyonephrosis cases were carried out in a retroperitoneally. All procedures were performed or supervised by the same surgeon.
RESULTS: The mean operative time was 269.85 minutes (range 145-360). The mean hemoglobin drop after surgery was 1.41 g/dl (range 0.3-2.3 g/dl). Difficult dissection was encountered in 13 cases (48.14%). Nine out of 13 interventions were carried out in a complete intracorporeal fashion, while conversion to open surgery was needed in 4 cases. Vascular complications involving the major blood vessels comprised of one case of inferior vena cava (IVC) tear. Digestive tract-related complications comprised two fistulas of the descending colon and one peritoneal breach. Multiorgan resection was performed in 6 cases.
CONCLUSIONS: Total nephrectomy in cases of XGPN and pyonephrosis is a challenging procedure. The laparoscopic approach is feasible, as most complications are resolved intracorporeally. However, it may remain reserved for large-volume centers with experienced surgeons.
摘要：
背景：黄色肉芽肿性肾盂肾炎（XGPN）是一种罕见的慢性肾脏炎症，由尿路长期阻塞引起的.肾脓是急性梗阻性肾盂肾炎的严重化脓性并发症。虽然微创方法有许多优点，肾脏的安全解剖可能并不总是可以实现的。
方法：我们回顾了27例诊断为XGPN或脓肾的病例，在2016年10月至2022年3月期间在我们部门接受了腹腔镜全肾切除术的患者.所有干预均使用KarlStorz3D腹腔镜系统进行。对于大多数XGPN，手术方法是标准的经腹膜肾切除术，而脓肾病例是在腹膜后进行的。所有程序均由同一外科医生执行或监督。
结果：平均手术时间为269.85分钟（范围145-360）。手术后的平均血红蛋白下降为1.41g/dl（范围为0.3-2.3g/dl）。13例（48.14％）遇到了困难的夹层。13项干预措施中有9项是以完全在体内的方式进行的，4例需要转换为开放手术。涉及主要血管的血管并发症包括1例下腔静脉（IVC）撕裂。消化道相关并发症包括两个降结肠瘘和一个腹膜破裂。多器官切除6例。
结论：在XGPN和脓肾的情况下进行全肾切除术是一项具有挑战性的手术。腹腔镜手术是可行的，因为大多数并发症都是在体内解决的。然而,它可能仍然保留给有经验的外科医生的大容量中心。
方法：我们回顾了27例诊断为XGPN或脓肾的病例，在2016年10月至2022年3月期间在我们部门接受了腹腔镜全肾切除术的患者.所有干预均使用KarlStorz3D腹腔镜系统进行。对于大多数XGPN，手术方法是标准的经腹膜肾切除术，而脓肾病例是在腹膜后进行的。所有程序均由同一外科医生执行或监督。
结果：平均手术时间为269.85分钟（范围145-360）。手术后的平均血红蛋白下降为1.41g/dl（范围为0.3-2.3g/dl）。13例（48.14％）遇到了困难的夹层。13项干预措施中有9项是以完全在体内的方式进行的，4例需要转换为开放手术。涉及主要血管的血管并发症包括1例下腔静脉（IVC）撕裂。消化道相关并发症包括两个降结肠瘘和一个腹膜破裂。多器官切除6例。
结论：在XGPN和脓肾的情况下进行全肾切除术是一项具有挑战性的手术。腹腔镜手术是可行的，因为大多数并发症都是在体内解决的。然而,它可能仍然保留给有经验的外科医生的大容量中心。
