105例肾结核临床诊治分析  

Diagnosis and treatment of renal tuberculosis:clinical analysis on 105 cases

作　　者：姚史武[1] 刘思平[1] 孙忠凯[1] 何强[1] 

机构地区：[1]梅州市人民医院泌尿外科,广东梅州514000

出　　处：《广州医学院学报》2012年第6期83-85,共3页Academic Journal of Guangzhou Medical College

摘　　要：目的:探讨肾结核的临床特点及诊治方法方法:回顾性分析1999年1月至2009年12月梅州市人民医院收治的105例肾结核患者的临床资料。结果:105例患者最常见的临床表现为膀胱刺激征(尿频、尿急、尿痛)和腰痛,分别为68.6%(72/105)和51.4%(33/105):27例患者症状不典型各种检查手段的阳性率分别是:尿抗酸杆菌阳性率28.2%(20/71)、尿TB-PCR阳性率57.5%(46/80);IVU诊断肾结核阳性率48.3%(42/87)、B超诊断肾结核阳性率23.7%(23/97)、CT诊断肾结核阳性率80.4%(74/92)。药物治疗47例中42例药物治疗后12～18个月尿液检查正常,B超或IVU显示病灶稳定或消失;5例肾结核在药物治疗6～12个月后无效或恶化,改行患肾切除。58例手术治疗中53例同时施行患侧输尿管切除术,术后病理诊断证实均为肾结核,随访1～3年无复发无转移。结论:尿TB-PCR阳性和IVU是目前诊断肾结核的主要手段,CT有一定的辅助诊断价值。临床肾结核发生率无明显下降,但并发症发生率明显下降,抗结核药物治疗效果显著增加。肾结核肾切除术应尽可能切除患侧输尿管。Objective： To investigate the clinical characteristics and methodology for the diagnosis and treatment of renal tuberculosis. Methods： We did a retrospective analysis on the clinical profiles of 105 patients with renal tuberculosis who were admitted to Meizhou People＇ s Hospital between January 1999 and December 2009. Results： The major clinical presentations consisted of bladder stimulation-namely, frequent mieturition, urgent urination and urodynia （68.6%, 72/105）, followed by lumbago （51.4% , 33/105）. Atypical symptoms appeared in 27 cases. The positive rates were 28.2% （20/71） for urine acid-fast bacilli staining, 57.5% （46/ 80） for urine tubereulosis-polymerase chain reaction, 48.3% （42/87） for intraudio vedioenous urography （IVU）, 23.7% （23/97） for uhrasonography and 80.4% （74/92） for CT. Of the 47 eases treated with ehemotherapy, 42 yielded normal findings of urine test and stabilized or absence of the lesion at ultrasonography or IVU following a 12-to-18-month treatment. The treatment appeared ineffective or failed at months 6 to 12 in 5 patients who subsequently received renal resection of the affected side. Of 58 patients who underwent surgery, 53 treated with additional urinary duct resection were diagnosed as having renal tuberculosis postoperatively yet did not show relapse or metastasis during the 1- to 3-year follow-up. Conclusion： The positive assay for TB-PCR or ]VU is the mainstay diagnostic criterion for renal tuberculosis, whilst CT may be of limited diagnostic significance. Although the incidence of renal tuberculosis did not appear clinically reduced, there has been a marked reduction in the comorbidity and improved efficacy of anti-tuberculous therapy. Resection of the affected urinary duct is strongly recommended for surgical treatment for renal tuberculosis.

关 键 词：肾结核 诊断 治疗 

分 类 号：R445.1[医药卫生—影像医学与核医学]