泌尿男生殖系结核课件_1.pptVIP

 Urologic and Male Genital Tuberculosis Yi Lin Department of urology Tianjin Medical University 概 述 泌尿、男生殖系结核 (urologic and male genital tuberculosis) 结核杆菌侵犯泌尿、男性生殖器官引起的慢性特异性感染。 约占全部肺外结合的14% 与经济落后、医疗水平底有关 好发年龄20~40岁青壮年 男性大于女性，2：1左右 概 述 原发性结核病: 首次感染结核菌, 引起的结核病-肺结核 继发性结核病: 有结核菌感染后, 已建立细胞免疫和变态反应后发生的结核病. 发病机理 人体首次感染结核菌—机体无免疫力—巨噬细胞不能杀死结核菌—结核菌蔓延—经淋巴或血液播散到全身—在各组织中着床—潜伏灶—一般情况下不发病—机体免疫力地下时或营养不良时—潜伏菌大量繁殖—发病 概 述 感染途径：4种 1. 血性感染：最常见 2. 接触感染：通过性生活或污染物传播，少见 3. 淋巴感染：罕见 4. 直接蔓延：罕见 泌尿、男生殖系统内部传播： 1. 顺行蔓延：肾—输尿管—膀胱 2. 逆行蔓延：膀胱—健侧输尿管—健侧肾脏 Etiology The kidney and possibly the prostate are the primary sites of tuberculous infection in the genitourinary tract. All other genitourinary organs become involved by either ascent ( prostate to bladder ) or descent ( kidney to bladder, prostate to epididymis). The testis may become involved by direct extension from epididymal infection. Pathogenesis A. kidney and ureter: A shower of TB hits the renal cortex, the organisms may be destroyed by normal tissue resistance. Only scars are found in the kidney. However, if enough bacteria of sufficient virulence become lodged in the kidney and are not overcome, a clinical infection is established. Pathogenesis A. kidney and ureter: Tuberculosis of the kidney progresses slowly; it may take 15~20 years to destroy a kidney in a patient who has good resistance to the infection. Therefore, there is no renal pain and little or no clinical disturbance of any type until the lesion has involved the calyces or the pelvis. It is only at this stage that symptoms ( of cystitis) are manifested. Pathogenesis A. kidney and ureter: As the disease progress, a caseous breakdown of tissue occurs until the entire kidney is replaced by cheesy material. Calcium may be laid down in the reparative process. The ureter undergoes fibrosis and tends to be shortened and straightened. This change leads to a “golf-hole” (gaping) ureteral orifice, typi