摘要
目的:总结西藏地区附睾结核的发病情况及临床诊治过程,以提高附睾结核的诊治能力。方法:回顾性分析2014年10月-2019年10月西藏自治区人民医院收治44例附睾患者的临床资料。结果:附睾结核住院患者占同期住院人数的1.3%,均为藏族,发病年龄高峰为40-60岁。临床体征主要为阴囊疼痛伴触痛(65.9%)、无痛性阴囊肿大(34.1%)、串珠样输精管(22.7%)及阴囊窦道(15.9%)。17例(38.6%)患者有肺结核史;35例病理检查确诊结核病,12例睾丸受累;7例行脓液涂片抗酸杆菌镜检,阳性率57.1%;4例行脓液结核分枝杆菌和利福平耐药基因(GeneXpert MTB/RIF)检测,阳性率100%。单纯抗结核药物治疗9例,35例在抗结核药物治疗同时给予手术干预。所有患者出院后随访4周-2年,非手术患者药物治疗效果良好;手术患者无复发。阴囊结核无复发。结论:本地区附睾结核患者仍以中老年患者为主,大多数患者缺乏特异性临床表现而易早期误诊,延误治疗。使用抗结核药物联合手术是附睾结核的有效治疗方法。
Objective: To summarize the incidence, diagnosis and treatment of epididymal tuberculosis in Tibet, and to increase the ability to diagnose and cure epididymal tuberculosis. Method: The clinical data of 44 patients with epididymal tuberculosis from October 2014 to October 2019 were collected and reviewed retrospectively. Result: Epididymal tuberculosis constituted 1.3% of the urological inpatients for 5 years’ duration. The patients were all Tibetan. The incidence was higher in the 40-60 years old patients. The common symptoms included painful scrotal swelling(65.9%), painless scrotal swelling(34.1%), vas deferens beaded appearance(22.7%) and scrotal sinuses discharging pus(15.9%). Histological examination of operative specimens identified granulomas and acid-fast bacilli in 35 patients, and testicular involvement was present in 12 patients. Seven cases were examined by acid-fast bacilli stain, with a positive diagnostic rate of 57.1%, and 4 cases were examined by GeneXpert MTB/RIF assay, with a positive diagnostic rate of 100%. Nine cases received chemotherapy with anti-tuberculosis drugs alone, while surgery was performed in 35 cases. The results showed good response to treatment during the follow-up period from four weeks to two years. Conclusion: In Tibet, the epididymal tuberculosis was higher in middle-aged and older population. It is difficult to diagnose early-stage epididymal tuberculosis, so its early diagnosis needs high level of suspicion and comprehensive analysis. Chemotherapy combined with surgical treatment is an effective and common approach to managing epididymal tuberculosis.
作者
王晋龙
王峰
罗锋
张宝鹏
李传洪
张中元
WANG Jinlong;WANG Feng;LUO Feng;ZHANG Baopeng;LI Chuanhong;ZHANG Zhongyuan(Department of Urology,People's Hospital of Tibet Autonomous Region,Lhasa,850000,China;Department of Urology,First Hospital of Peking University)
出处
《临床泌尿外科杂志》
2020年第9期725-728,共4页
Journal of Clinical Urology
关键词
结核
西藏
附睾
临床特点
tuberculosis
Tibet
epididymal
clinical characteristics
