摘要
目的:探讨不典型中晚期肾结核的临床表现及诊治方法.方法:回顾性分析14例不典型中晚期肾结核的临床资料.结果:14例患者主要表现为血尿、腰痛、尿频、肾积水.尿常规异常86%(12/14),尿沉渣找抗酸杆菌阳性率33%(3/9),尿TB-PCR阳性率25%(1/4),静脉尿路造影患肾不显影57%(8/14),CT确诊率80%(8/10).1例行药物治疗,13例行手术治疗.14例随访1～4年均治愈,发生输尿管残端综合征1例.结论:临床症状不典型以及部分病例起病隐匿,是导致中晚期肾结核误诊的重要原因.CT对中晚期肾结核的诊断最有价值,螺旋CT尿路成像或MRU 对并发输尿管结核的诊断有帮助.治疗上仍以肾切除为主,术中应尽可能切除患侧输尿管.
Objective:To investigate the clinical manifestation,diagnosis and treatment of atypical mid to end stage renal tuberculosis . Methods:14 cases of atypical mid to end stage renal tuberculosis were analysed retrospectively .Results:Gross hematunia, lumbago, urinary frequency and unilateral hydronephrosis were the most common symptoms in 14 cases . The positive rate of urinary analysis , acid fast strains and urinary TB-PCR were 86%(12/14),33%(3/9)and 25%(1/4)respectively .Intravenous urography indicated no image of involved kidney in 8 cases (57%), the diagnostic accuracy of CT were 80%(8/10). Treatments consisted of antituberculosis chemotherapy in 1 case and surgery in 13 cases .Followed up for 1-4 years , all the cases were cured , of them 1 case developed ureteral stump syndrome . Conclusions:Atypical symptoms and asymptoms in earlier stage are the main causes of the mid to end stage renal tuberculosis . CT is the most valuable in the diagnosis of the mid to end stage renal tuberculosis , Spiral CT urography or MRU is helpful for the diagnosis of combination with ureteral tuberculosis . Nephrectomy is still the main treatment for it and the involved ureter should be concomitantly resected as much as possible during the operation .
出处
《临床泌尿外科杂志》
2005年第5期264-266,共3页
Journal of Clinical Urology
关键词
结核
肾
诊断显像
肾切除
Tuberculosis, renal
Diagnostic imaging
Nephrectomy
