摘要
目的总结不典型肾结核的诊治经验，提高肾结核的诊治水平。方法回顾性分析1993年5月～2006年9月诊治的24例不典型肾结核患者的临床资料。本组患者以腰背痛和肉眼血尿为最常见临床症状，分别占50．0％和41．7％。24h尿抗酸杆菌和尿结核聚合酶链反应（TB-PCR）的阳性率分别为10．5％和33．3％，静注尿路造影、逆行输尿管肾盂造影及CT的诊断符合率分别为31．6％、14．3％和58．3％。结果药物治疗6例，手术治疗18例，包括肾切除和输尿管远端切除加膀胱肌瓣成形术等。1例并发血行播散型肺结核死亡，2例失访，余21例随访4个月至4年均治愈，1例因膀胱挛缩而行回肠扩大膀胱术。结论不典型肾结核的诊断应受到临床医师的高度警惕和重视，排除膀胱肿瘤、结石、非特异性炎症等，综合应用尿路造影、尿细菌学、CT、超声检查等方法早期诊断。早期患者可用药物治愈，晚期患者在药物治疗基础上采用手术治疗。
Objective To summarize the experience in diagnosis and treatment of untypical renal tuberculosis for improving therapeutic efficacy for the disease. Methods The data of 24 cases with untypical renal tuberculosis ,from May 1993 to September 2006, were analysed retrospectively. Lumbodorsal pain （50.0%）and gross hematuria （41.7%） were the most common symptoms encountered in this cohort of patients. Acid-fast stains on urinary sediment were positive in 10.5% ,and urine TB-PCR test was positive in 33.3%. The diagnostic accuracy of IVU,retrograde urography and CT scan were 31.6%, 14.3% and 58.3%, respectively. Results Antituberculosis chemotherapy was carried in 6 cases,and surgical treatments including nephrectomy and Bori flap ureterecystoplasty in 18 cases. One patient died for systemic miliary tuberculosis,2 cases were lost follow-up. Twenty-one cases were followed up from 4 months to 4 years,and the renal tuberculosis in all cases was cured, 1 case received ileecystoplasty because of the bladder contracture. Conclusions The diagnosis of untypical renal tuberculosis needs urologists＇ alert and meticulous workup to rule out tumorous,lithic and interstitial disease of the bladder. The combination of IVU, CT scan, urine culture and ultrasonography may reach the early diagnosis of the disease. Medical therapy can cure the early case, but surgical interventions are needed for later stage of the disease.
出处
《中国医师进修杂志（外科版）》
2007年第7期32-34,共3页
Chinese Journal of Postgraduates of Medicine
关键词
结核病
肾脏
诊断
治疗
Tuberculosis
Kidney
Diagnosis
Treatment
