临床型肾结核Kub分期分型及治疗的初步探讨  

Preliminary exploration of Kub stage classification and treatment of clinical renal tuberculosis

作　　者：杨荣权 杨立 杨银桂 刘畅 王彦文 李杏杰 胡彪 Yang Rongquan;Yang Li;Yang Yingui;Liu Chang;Wang Yanwen;Li Xingjie;Hu Biao(Department of Urology,The First Afiliated Hospital of Dali University,Dali 671000,China)

机构地区：[1]大理大学第一附属医院泌尿外科,大理761000

出　　处：《中华泌尿外科杂志》2024年第3期168-174,共7页Chinese Journal of Urology

摘　　要：目的探讨临床型肾结核的Kub分期分型,为病情评估及治疗策略制订提供参考。方法回顾性分析2011年1月至2022年12月大理大学第一附属医院收治的180例肾结核患者的临床资料。男82例,女98例;年龄(44.56±9.62)岁;结核病灶位于左肾101例,右肾79例;病灶局限/多发118例,广泛破坏62例;输尿管侵犯165例,膀胱侵犯139例。保肾治疗方法包括输尿管狭窄置管扩张术、经皮肾造瘘术、结核病灶清除术、肾部分切除术、输尿管重建及乙状结肠膀胱扩大重建;患肾切除采用腹腔镜或开放手术。以患者影像学检查和内镜检查结果作为分期分型依据,按结核病灶侵犯肾脏(K)、输尿管(u)和膀胱(b)的病情程度进行分期,各分为4个期(K期:K_(1-4)期;u期:u_(0~3)期;b期:b_(0-3)期)。再将每种病灶分期组合后结合病情进行分型:局部肾内型(K_(1~2)u_(0)b_(0)期)、局部肾-输尿管累及型(K_(1-2)u_(1~2)b_(0~2)期)、多发肾-输尿管侵犯型(K_(3)u_(1~3)b_(0~2)期)和广泛破坏型(K_(4)u_(l-3)b_(l~3)期)。分析各分型患者的治疗及预后情况。结果180例患者中,局部肾内型15例,均行保肾治疗,其中6例(4例K_(2a)u_(0)b_(0)期和2例K_(2b)u_(0)b_(0)期)患者行单纯抗结核药物治疗2年,获临床治愈;4例K_(2a)u_(0)b_(0)期患者抗结核药物治疗结合肾部分切除术后随访2年,获临床治愈;5例K_(2b)u_(0)b_(0)期患者行输尿管镜检+双J管置人引流,双J管置入2年后拔除,随访病情稳定。局部肾-输尿管累及型47例,均先行保肾治疗,其中5例K_(1)u_(0),b_(0-2)期患者获临床治愈,3例K_(2a)u_(1~2)b_(0~2)期和7例K_(2b)u_(1~2)b_(0~2)期患者后期因病情进展行患肾切除术,其余患者病情稳定。多发肾-输尿管侵犯型56例,24例K_(3)u_(1~2)b_(0-2)期患者中9例病情稳定,15例后期行患肾切除术;32例K_(3)u_(3)b_(0-2)期患者均行患肾切除术。广泛破坏型62例,均行患肾切除术。局部肾-输尿管累及型和多发肾-输尿管侵犯Objective To investigate the Kub stage classification of clinical renal tuberculosis and provide a reference for disease evaluation and management.Methods A retrospective analysis was conducted on clinical data from 180 patients diagnosed with renal tuberculosis who were admitted to the First Affliated Hospital of Dali University between January 2011 and December 2022.The 180 cases included 82 males and 98 females.The average age was(44.56±9.62)years.The tuberculosis lesions of 101 cases were on left kidney,while that of 79 cases were on right kidney.Localized/multiple lesions were observed in 118 cases,whereas extensive destruction was found in 62 cases.Moreover,the ureters were involved in 165 cases,and bladder invasion occurred in 139 cases.For patients undergoing renal preservation treatment,a comprehensive approach was employed,including ureteral stricture stenting and regular replacement of double-J stent,percutaneous nephrostomy,excision of tuberculosis lesions or partial nephrectomy,ureter reconstruction,and sigmoidocystoplasty.In cases requiring nephrectomy,either laparoscopic or open surgical approaches are utilized.Based on the results of patient imaging and endoscopy,staging and classification were performed based on the extent of tuberculosis lesions involving the kidneys(K),ureters(u),and bladder(b).The state for each above organ was divided into four stages:K stage(Ki_(1-4)),u stage(u_(0)-u_(3)),and b stage(b_(0)-b_(3)),which were then combined with the actual disease condition for further categorization.The classifications included local intrarenal type(K_(1-2) u_(0)b_(0)),local renal-ureteral involvement type(K_(1-2) u_(1-2) bo_(1-2)),multiple renal-ureteral invasion type(K_(3),u_(1-3) b_(0-2))and extensive destruction type(Kyuigbi-3).Further analysis was conducted on kidney preservation and subsequent disease progression among patients with different subtypes.Results Among the 180 patients,15 cases of local intrarenal type underwent kidney-preserving treatment.Out of these cases,6 patients(4 pa

关 键 词：肾疾病 结核 分期分型 外科治疗 

分 类 号：R527.1[医药卫生—内科学]