中、晚期肾结核40例临床分析  

Diagnostic and Treatment of Advanced Renal Tuberculosis(Report of 40 Cases)

作　　者：谢军 陈光耀 梁健峰 

机构地区：[1]广东省阳江市人民医院泌尿外科,阳江529500

出　　处：《热带医学杂志》2008年第9期930-932,共3页Journal of Tropical Medicine

摘　　要：目的探讨中晚期肾结核的临床表现特征及其有效治疗方法。方法对40例中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、红细胞沉降率、尿抗酸杆菌、尿结核杆菌-PCR(Tb-PCR)、B超、静脉尿路造影(IVU)、CT等检查,8例患者行药物治疗,32例患者行手术治疗。结果临床表现为腰痛18例(45%),膀胱刺激症24例(60%),血尿28例(70%)。尿常规检查异常38例(95%),红细胞沉降率异常升高36例(90%),尿抗酸杆菌阳性11例(27.5%),尿结核杆菌-PCR(Tb-PCR)阳性18例(45%)。B超检查肾积水、肾结石或/和肾结构异常40例(100%);静脉尿路造影(IVU)确诊肾结核23例(57.5%),患肾不显影17例(42.5%);CT确诊肾结核31例(77.5%)。肾结核合并膀胱结核16例,肺结核5例,附睾结核8例。8例患者药物治疗治愈,32例患者手术后经病理确诊为肾结核。结论中晚期肾结核的临床表现多不典型,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。尿沉渣染色查抗酸杆菌仍重要,尿Tb-PCR检查是术前确诊肾结核的主要手段,IVU和B超可作为泌尿系结核诊断首选的影像学检查,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。Objective To explore the clinical characteristics and treatment of advanced renal tuberculosis. Methods Data of advanced renal tuberculoses of 40 cases were analyzed. All the cases were performed urinary analysis, B type ultrasonography, intravenous urography （IVU） and computerized tomography, etc. 8 cases were treated with medicine, and 32 cases were treated with operation. Results Clinical symptom has lumbodynia 45%, irritation symptoms 60%, and hematuria 70%. The positive rates of urinary analysis and ESR were 95% and 90%, respectively. The positive rates of acid fast stains and urinary TB PCR were 27.5% and 45%, respectively. B type ultrasonography showed that hydronephrosis and kidney stones and/or kidney structure was 100% （40 cases）. Intravenous urograpby confirmed the diagnosis in 23 cases（57.5%） and indicated no image of involved kidney in 17 cases（42.5%）. The diagnosis accuracy of computerized tomography was 77.5%（31 cases）. The 8 cases treated with medicine were all cured, and the 32 cases under going surgery were pathologically diagnosed to have renal tuberculosis. Conclusion The advanced renal tuberculosis was lack of classic clinical features. The diagnosis should not rely mainly on the classical irritation symptoms, but should combine with the laboratory tests image analysis. Acid fast stains remains as an important pathogen detecting tool. Urinary TB PCR is the major diagnosis before operation. IVU and B type uhrasonography are the first choice for imaging diagnosis, and CT scan may provide additional helpful information. When surgical intervention is needed, nephrectomy and partial ureterectomy is the first choice.

关 键 词：肾结核 诊断 治疗 

分 类 号：R527.1[医药卫生—内科学]