87例肾结核的临床探析.pdfVIP

摘 要 87 例肾结核的临床分析 研究生：陈毅来 导师：王玉杰 摘 要 目的:探讨肾结核的临床特点和诊治方法，以提高肾结核的诊治水平。方法:回顾 性分析了我院泌尿外科于1997 年～2007 年收治的肾结核87 例，分别从临床资料、 实验室检查及影像学检查等方面分析总结了全部病例的特点。结果:肾结核以 31-50 岁年龄段发病率最高，其典型临床特征为膀胱炎的症状；尿频、尿急、尿痛。除此 之外，还可表现为腰痛及血尿、脓尿。有很少一部分表现为发热、体重减轻、盗汗 等结核感染症状。合并肺结核比例占9.2%，不典型肾结核病例占53%。11 例病人做 了尿沉渣抗酸染色,1 例为阳性，3 例患者行尿结核杆菌培养阴性。本组行 PCR-TB-DNA 检查仅1 例，结果阴性。B 超检查、KUB+IVU 检查、CT 检查诊断符 合率分别为68%、75%、84%。70 例患者行肾输尿管切除术，4 例行膀胱扩大术,9 例 行活检术，5 例患者行膀胱输尿管重吻合术，4 例行膀胱造瘘术。手术后均抗结核治 疗6 个月。单纯药物治疗肾结核4 例，76 例随访病人均治愈。结论:肾结核发病高峰 年龄为31-50 岁。肾结核早期诊断困难，需综合分析临床表现、实验室检查及影像学 检查。凡怀疑肾结核病人，均应常规行尿常规、尿涂片找抗酸杆菌、尿PCR- TB-DNA、 静脉尿路造影及肾脏CT 以及膀胱镜等相关检查。泌尿系B 超、静脉尿路造影及CT 对肾结核的诊断有较大帮助。早期肾结核的治疗以药物治疗为主。中晚期肾结核以 手术切除为主,术前、术后辅以抗痨治疗。 关键词：结核；肾脏；诊断 —1— 新疆医科大学医学硕士学位论文 The Clinical Analysis of 87 Cases of renal Tuberculosis Postgraduate: Chen Yi Lai Supervisor: Wang Yu jie Professor Abstract Objective:In order to improve the level of diagnosis and treatment, the clinical features, diagnosis and therapy of renal tuberculosis were analyzed. Method:eighty seven cases of renal tuberculosis obtained from our hospital in 1997～2007 were retrospectively studied. Those cases were analyzed respectively from clinical data laboratory findings. Results:The incidence of renal tuberculosis were highest among age 31to50 years old. The most frequent symptom of disease was typical cystitis: urinary frequency urgency odynuria. Furthermore hematuria lumbodynia and pyuria also frequent present. The few proportion of patients have other symptoms such as febrile loss of weight, night sweat. The proportion of complicating pulmonary