中晚期肾结核86例临床分析  

Diagnosis and Treatment of Advanced Renal Tuberculosis

作　　者：张盈中[1] 高飞 云志中[1] 

机构地区：[1]内蒙古自治区医院泌尿外科,内蒙古呼和浩特010017 [2]内蒙古第四医院,内蒙古呼和浩特010080

出　　处：《内蒙古医学杂志》2008年第12期1472-1474,共3页Inner Mongolia Medical Journal

摘　　要：目的：探讨中晚期肾结核的诊断与治疗方法，提高肾结核的诊治水平。方法：对近8年来86例中晚期肾结核患者的临床资料进行回顾性分析。结果：尿路刺激征和血尿为最常见的症状，分别为92％和49％。尿沉渣涂片查抗酸杆菌的阳性率为38％。尿TB—PCR检测的阳性率是42％。超声、静脉尿路造影、CT和MRU检查的诊断符合率分别是41％、65％、97％和100％。73例进行肾及部分输尿管切除术加抗结核治疗。结论：超声、静脉尿路造影和CT可作为诊断泌尿系结核首选的影像学检查，尿沉渣染色查抗酸杆菌、尿Tb—PCR仍应作为术前肾结核诊断的重要方法，CT诊断晚期’肾结核的阳性率高于超声和静脉尿路造影，必要时结合肾脏及尿路核磁共振水成像检查（MRU）。主要治疗方法为肾及输尿管切除术。术后采用异烟肼＋复合利福平＋吡嗪酰胺＋乙胺丁醇联合化疗，疗程1～1．5年。Objective： To explore the diagnosis and treatment for the improvement of the diagnostic accuracy and therapeutic efficacy of the advanced renal tuberculosis. Methods： The clinical date of 86 cases of advanced renaltuberculosis were analyzed retrospectively in recent 8 years. Results： Irritation symptoms 92% and gross hematuria 49 % were the most common symptoms encountered in these patients. Acid-fast stains on urinary sed- iment were positive in 38 % of cases. The positive result of urinary TB - PCR were 42 %. The diagnostic accuracy of B-type ultrasonography, IVU, CT and MRU in these patients were 41%, 65%, 97% ang 100% respectively. 73 patients underwent a nephrectomy and partial ureterectomy and Anti-tuberculosis chemo therapyo Conclusion.B- type ultrasonography, IVU and CT are the first choice for imaging diagnosis： acid-fast stains remains an important pathogen-detecting tool;TB-PCR in urine can provide important reference for the diagnosis instrument before operation, CT scan is more reliable than B - type ultrasonography and IVU in the diagnosis of advanced renal tuberculosis. When surgical intervention is needed, nephrectomy and partial ureterectomy is the first choice, Regular chemotherapy is necessary.

关 键 词：肾结核 诊断 治疗 

分 类 号：R527.1[医药卫生—内科学]