肾结核患者的外科诊治体会  

Surgical diagnosis and treatment of renal tuberculosis

作　　者：高剑[1] 罗冬喜[1] 宫敬[1] 杨勇[1] 陈磊[1] 杨向利[1] 

机构地区：[1]武汉科技大学附属医院泌尿外科,430064

出　　处：《中国综合临床》2010年第11期1211-1212,共2页Clinical Medicine of China

摘　　要：目的 探讨肾结核的诊断和治疗方法.方法 回顾分析42例肾结核患者的临床资料,总结其诊断和治疗经验.结果 肾结核最常见的症状为膀胱刺激症状（78.6%,33/42）和血尿（64.3%,27/42）.尿常规异常为83.3%（35/42）,尿沉渣涂片找抗酸杆菌阳性率为28.6%（12/42）;B超、静脉尿路造影（IVU）、逆行肾盂造影、CT的阳性率分别为19.0%（8/42）、33.3%（14/42）、26.2%（11/42）和71.4%（30/42）.36例行手术治疗;6例患者予抗结核治疗,3例痊愈,3例6～12个月后因患肾功能严重损害而行肾及部分输尿管切除术;39例手术患者术后病理检查均证实为肾结核.结论 肾结核的临床诊断应综合病史、尿液分析及影像学检查等多种方法.抗结核治疗需严密随访,对肾脏破坏严重或无功能肾应行手术切除.Objective To study the surgical diagnosis and treatment of renal tuberculosis（TB）. Methods The clinical data of 42 cases with renal TB were analyzed retrospectively and the experiences of clinical diagnostic and treatment were summarized. Results Cystic irritation symptoms（78.6% ,33/42）and gross hematuria（64. 3%,27/42）were the most common symptoms in these patients. Abnormal urine were found in 83.3 % cases. Acid-fast stains on urinary sediment were positive in 28.6%（12/42）of cases. The diagnostic accuracy of B-ultrasonicgraphy,IVU,retrograde pyelography and CT examination in these patients were 19.0%（8/42）,33.3% （14/42）,26.2%（11/42）and 71.4%（30/42）respectively. Among all cases enrolled in the study,6 patients received antiphthisic medicine treatment,3 of them were cured and the other 3 accepted nephrectomy and partial ureterectomy after 6-12 months because of severe renal function impairment 36 cases received surgical treatment. In the 39 cases treated with operation,all of them were proved to carry renal tuberculosis by the postoperative pathological examinations. Conclusions The medical history,urine analysis,image examination should be considered synthetically in the clinical diagnosis of renal tuberculosis. The patients should be followed up closely during antiphthisic treatment period. Seriously damaged or nonfunctioning kidney should be removed promptly.

关 键 词：肾结核 外科手术 

分 类 号：R527.1[医药卫生—内科学]