肾移植术后结核性脓肿延误诊断回顾性分析  

Retrospective analysis of delayed tuberculous abscess diagnosis after renal transplantation

作　　者：钟明达 蓝恭斌[1] 胡善彪[1] 彭龙开[1] 谢续标[1] 李炎瑾 Zhong Mingda;Lan Gongbin;Hu Shanbiao;Peng Longkai;Xie Yanbiao;Li Yanjin(Department of Kidney Transplantation,The Second Xiangya Hospital of Central South University,Changsha 410000,Hunan,China)

机构地区：[1]中南大学湘雅二医院肾脏移植科,湖南长沙410000

出　　处：《实用器官移植电子杂志》2023年第5期451-456,共6页Practical Journal of Organ Transplantation(Electronic Version)

基　　金：湖南省自然科学基金(2023JJ30755)。

摘　　要：目的 肾移植术后患者结核病感染风险增高,而对于肾移植术后结核性脓肿却罕见报道。本文将探讨肾移植术后结核性脓肿的临床诊治方法及延误诊断原因。方法 本文回顾性分析了2015年1月至2023年1月于中南大学湘雅二医院行公民逝世后器官捐献供肾肾移植手术共计2173例,术后诊断为结核病的患者共40例,其中结核性脓肿患者3例,观察结核性脓肿患者发病特点、诊治方案及预后并进行分析。结果 40例肾移植术后结核病患者中有3例为结核性脓肿。肾移植至起病的平均时间为15个月。患者从第1次就诊到抗结核治疗起始的平均时间为35.7 d,至病原学确诊结核脓肿的平均时间为86.3 d。抗结核及引流治疗后均得到有效控制,肌酐较治疗前无明显变化。结论 对于肾移植术后出现脓肿的患者,无论有无肺结核表现,应保持结核性感染可能的警惕性。尤其是经常规治疗症状无好转患者,应尽早留取标本行病原学及分子生物学检查以明确诊断。对于该类患者规律抗结核及引流治疗缺一不可,治疗效果良好。Objective There is an increased risk of tuberculosis infection after kidney transplantation,but tuberculous abscess after kidney transplantation is rarely reported.This article will discuss the clinical diagnosis and treatment of tuberculous abscess after kidney transplantation and the causes of delayed diagnosis.Methods A total of 2173 patients who underwent deceased donor kidney transplantation in the Second Xiangya Hospital of Central South University from January 2015 to January 2023 were analyzed retrospectively.A total of 40 patients were diagnosed with tuberculosis post renal transplant,including 3 patients with tuberculous abscess.The clinical manifestations,diagnosis,treatment and prognosis of patients with tuberculous abscess were observed and analyzed.Results The mean time from kidney transplantation to the onset of the disease in 3 patients with tuberculous abscess was 15 months.The mean time from the onset to the start of antituberculosis therapy was 35.7 d and the mean time from onset to etiological diagnosis was 86.3 d.The anti-tuberculous and drainage treatment were effective.And serum creatinine had no significant change compared with that before treatment.Conclusion For patients with abscess after kidney transplantation,it is necessary to keep alert of the possibility of tuberculous infection.Especially for patients whose symptoms do not improve after conventional treatment,it is necessary to collect samples for etiological and molecular biological examination as soon as possible to confirm the diagnosis.For this kind of patients,the prognosis is favorable after regular anti-tuberculosis and drainage therapy at the same time.

关 键 词：结核性脓肿 肾移植 延误诊断 

分 类 号：R699.2[医药卫生—泌尿科学] R52[医药卫生—外科学]