摘要
目的 探讨活动性肾上腺结核的诊断及治疗.方法 回顾性分析我院2016年11月1日收治的1例肾上腺结核患者的临床资料,并复习相关文献.患者男,54岁.因干咳伴间断发热9个月余,发现左肾上腺占位1周入院.查体：左肾区叩痛阳性.外院诊断为左肾上腺占位,行左肾上腺肿物穿刺活检,提示为慢性炎症,抗炎对症治疗后发热症状仍无明显缓解,来我院就诊.血培养及尿培养均为阴性,PPD试验（-）,血液结核抗体（＋）,尿找抗酸杆菌3次均为阴性.胸部CT检查不排除间质性肺结核.肾上腺增强CT检查示肿物病灶呈少量分隔,轻度强化,可见多发条索状钙化影.初步诊断为左肾上腺占位、左肾上腺脓肿待排除、左肾上腺结核待排除.予患者规律使用抗结核药物（异烟肼0.3 g/d,利福平0.45 g/d,乙胺丁醇0.6 g/d）,3d后体温正常.因患者左肾上腺占位较大,约6.8 cm＆#215;5.5cm,难与肿瘤相鉴别,抗结核治疗2周后全麻下行后腹腔下左肾上腺肿物切除术.术中见左肾上腺肿物呈灰黄色,肿物上极与脾脏及胰腺粘连,仔细游离后顺利切除肿物.结果 手术过程顺利,手术时间85 min,术中出血量约50 ml.病理检查回报为肾上腺结核.术后患者继续抗结核治疗（异烟肼0.3 g/d,利福平0.45g/d,乙胺丁醇0.6g/d）6个月,患者无发热.术后随访1年,患者无不适,皮质醇节律均正常,未行激素替代治疗.结论 肾上腺肿物伴有反复发热、抗生素治疗无效者;CT扫描示肾上腺钙化、增大,伴有肾上腺外结核者,可诊断为活动性肾上腺结核,应给予抗结核治疗,但若结核体积较大或不排除肿瘤疾病,建议行肾上腺肿物切除术进一步明确诊断.
Objective To investigate the diagnosis and treatment of active adrenal tuberculosis.Method The clinical data of 1 patients with adrenal tuberculosis was retrospectively analyzed and the related literatures were reviewed.The male patient,54 years old,complained abuot the dry cough and intermittent fever for 9 months.He was found the left adrenal gland tumor for 1 weeks and admitted to our hospital on November 1st,2016.The physical examination showed the obvious left kidney percussion tellderness.The local hospital,considered the left adrenal tumor.The pathological diagnosis of left adrenal tumor by biopsy was chronic inflammation.The patient accepted anti-inflammatory therapy,but his symptom was not relieved.In our hospital,blood bacterial culture and urine bacterial culture and PPD was negative.Blood tuberculosis antibody was positive.Triple acid-fast bacilli were negative in urine.Chest CT did not exclude the interstitial pulmonary tuberculosis.Adrenal contrast-enhanced CT showed mild enhancement,strip calcification shadow.Primary diagnosis was left adrenal tumor,which the abscess and tuberculosis could not to be excluded.Then,the patient accepted regularly anti-tuberculosis therapy （Isoniazid,0.3 g/d,rifampicin,0.45 g/d,ethambutol,0.6 g/d）.Mter 3 days,his temperature returned to normal.Since the left adrenal mass was too large,which was about 6.8 cm ＆#215; 5.5 cm,to distinguish with the tumor,the patient accepted successfully retroperitoneal adrenal tumor resection two weeks later.The left adrenal tumor surface was greyish and yellow,which was adherent with spleen and pancreas.After carefully separating,the tumor was successfully removed.Result The operation was successful,which last 85 min.Intraoperative blood loss was about 50 ml.Pathological report showed adrenal tuberculosis.The patients accepted regularly antituberculosis therapy（Isoniazid,0.3 g/d,rifampicin,0.45 g/d,ethambutol,0.6 g/d） for half a year,and followed up for 1 year after operation.No further hormone replacement therapy was used.No f
作者
任瑞民
尚吉文
马丁
张雁钢
Ren Ruimin Shang Jiwen Ma Ding Zhang Yangang(Department of Urology, Shanxi Dayi Hospital, Shanxi Academy of Medical Sciences, Taiyuan 030032, Chin)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2017年第9期698-701,共4页
Chinese Journal of Urology
基金
山西省自然科学基金面上项目（2014011042-2）
关键词
肾上腺结核
诊断
治疗
Adrenal tuberculosis
Diagnosis
Therapy
