输尿管结核3例并文献复习  

Ureteral tuberculosis:a report of 3 cases and literature review

作　　者：肖世伟[1,2] 李亚楠 杨秀书[1] 袁东波[1] 朱建国[1] XIAO Shiwei;LI Yanan;YANG Xiushu;YUAN Dongbo;ZHU Jianguo(Department of Urological Surgery,Guizhou Provincial People’s Hospital,Guiyang,Guizhou 550002,China;Department of Urological Surgery,The Second Affiliated Hospital of Kunming Medical University,Kunming,Yunnan 650101,China;College of Pharmacy,Guizhou University of Traditional Chinese Medicine,Guiyang,Guizhou 550025,China)

机构地区：[1]贵州省人民医院泌尿外科,贵州贵阳550002 [2]昆明医科大学第二附属医院泌尿外科,云南昆明650101 [3]贵州中医药大学药学院,贵州贵阳550025

出　　处：《安徽医药》2020年第8期1537-1541,共5页Anhui Medical and Pharmaceutical Journal

基　　金：贵州省高层次创新型人才项目(黔科合平台人才〔2018〕5639)。

摘　　要：目的探讨输尿管结核的诊治方法。方法回顾分析贵州省人民医院2017年1月至2019年1月收治的3例输尿管结核病例资料并复习相关文献。结果 1例以输尿管狭窄行多次输尿管镜检查、狭窄段球囊扩张、输尿管支架管引流治疗,最终行肾输尿管全长切除术;1例行腹腔镜肾输尿管全长切除术;第3例行输尿管镜检查、狭窄段内切开、输尿管活检、输尿管支架管引流术。3例T细胞斑点实验(T-SPOT.TB)均阳性,1例尿结核杆菌DNA阳性。术后病理结果均为输尿管结核。随访8~16个月,平均12个月,预后良好。结论 T-SPOT.TB、多层螺旋CT、尿结核杆菌DNA,具有较高的诊断价值,成为诊断泌尿系结核主要的手段;输尿管镜有助于提高诊断率,可考虑应用于临床;对于输尿管结核而言,早期诊断、引流及有效的抗结核治疗可保护肾脏功能,减少肾脏的丢失。Objective To investigate the diagnosis and treatment of ureteral tuberculosis.Methods The clinical data of 3 cases of ureteral tuberculosis in Guizhou Provincial People’s Hospital from January 2017 to January 2019 were retrospectively analyzed and relevant literatures were reviewed.Results One patient with ureterostenosis was treated by multiple ureteroscopy,balloon dilatation of the stenotic segment and ureter stent drainage,and finally a nephro-ureterectomy with bladder-cuff was performed.One patient was treated with laparoscopic nephro-ureterectomy with bladder-cuff.The third patient was treated with ureteroscopy,mucosabiopsy and endoureterotony combined with internal ureteral stenting.All 3 cases of T-cell spot test for tuberculosis infection(T-SPOT.TB)were positive,and 1 case of urinary-tuberculosis DNA was positive.Postoperative pathological results were all ureteral tuberculosis.Follow-up for 8-16 months,with an average of 12 months,showed a good prognosis.Conclusion T-SPOT.TB,multi-slice spiral CT and urinary-tuberculosis DNA have high diagnostic values and become the main means of diagnosing urinary tuberculosis.Ureteroscopy is helpful to improve the diagnostic rate and can be considered for clinical application.For ureteral tuberculosis,early diagnosis,drainage and effective antituberculosis therapy can protect renal function and reduce renal loss.

关 键 词：结核 泌尿生殖系统 输尿管镜检查 输尿管结核 酶联免疫斑点测定 诊断 治疗 

分 类 号：R527.4[医药卫生—内科学]