晚期肾结核54例临床诊治分析

目的：探讨晚期肾结核的临床表现特征及其有效治疗方法.方法：对54例晚期肾结核患者的临床资料进行回顾性分析.对所有患者进行尿常规、B超、静脉尿路造影（CIV）、CT检查,50例患者行手术治疗.临床表现为腰痛37例（68.5%）,膀胱刺激症31例（57.4%）,全身中毒症状29例（53.7%）,血尿18例（33.3%）.结果： 尿常规检查异常54例（100%）,红细胞沉降率异常升高28例（51.9%）,尿抗酸杆菌阳性13例（24.1%）;B超检查肾积水﹑肾结石或/和肾结构异常51例（94.4%）;静脉尿路造影（IVU）确诊肾结核12例（22.2%）,患肾不显影31例（57.4%）;CT确诊肾结核38例（70.4%）.肾结核合并膀胱结核11例,肺结核8例,骨结核3例,附睾结核8例,前列腺结核2例.50例患者手术后经病理确诊为肾结核,随访1～9年治疗效果稳定,未发现泌尿系结核.结论：晚期肾结核的临床表现属不典型性,其诊断应在结合临床表现的前提下以实验室检查与影像学诊断为主.B超诊断晚期肾结核无特异性,CT诊断晚期肾结核的价值优于B超及IVU.治疗仍以手术切除肾脏为主,应尽可能切除患侧全程输尿管.

Diagnostic and treatment analysis of advanced renal tuberculosis(report of 54 cases)

Objective: To explore the clinical characterristics and treatment of advanced renal tuberculosis. Methods: Data of advanced renal tuberculoses of 54 cases (36 males and 18 females) were analysed. Their age ranged 28 to 64 years old (mean age, 46 years ). Lumbodynia 68.5%, irritation symptoms 57.4%, hematuria 33.3%, and toxic symptom of tuberculosis 53.7%. Results: The positive rate of urinary analysis and ESR were 100% and 51.9% respectively . The positive result of acid fast stains were 24.1%. B type ultrasonography performed in 51 cases (94.4%), were hydronephrosis and kidney stones and/or kidney structure is unusual . Intravenous urography confirms the diagnosis in 12 cases (22.2%) and indicated no image of involved kidney in 31 cases (57.4%). The diagnosis accuracy of computerized tomography was in 38 cases (70.4%). There were bladder tuberculosis in 11 cases, pulmonary tuberculosis in 8 cases, bone tuberculosis in 3 cases, epididymis tuberculosis in 8 cases, prostate tuberculosis in 2 cases. Fifty cases undergoing surgery were pathologically diagnosed to have renaltuberculosis. The follow-up of 50 cases was 1~9 years months after operation, During following up, the curative effect was stable. Conclusion: The advanced renal tuberculosis were lack of classic clinical pictures, it diagnosis that should not rely mainly on the fact that the classical irritation symptoms, hematuria to check and learn to diagnose with the image with the laboratory on the premise of combining clinical manifestation as the main fact. B type ultrasonography can not be regarded as a specific examination for advanced renal tuberculosis. Treatment still rely mainly on the fact that on the basis of medication. When nephroureterectomy is indicated, the involoed ureter should be excised as much as possible.