中晚期肾结核30例临床剖析.docVIP

中晚期肾结核30例临床剖析 　　【摘要】目的:探讨中晚期肾结核的诊断和治疗方法。方法:回顾性分析30例中晚期肾结核的临床资料。结果:下尿路刺激症状18例(60%),血尿8例(26.7%),腰痛6例(20%),尿常规异常28例(93.3%),尿抗酸杆菌阳性率8例(26.7%),B超,IVU,CT诊断符合率分别为30%,53.3%,80%。6例行抗结核保守治疗,20例行患肾加输尿管切除术,4例行无功肾切除,对侧输尿管腹壁造口术。结论:尿常规异常伴反复发作的下尿路刺激症状应高度怀疑肾结核,尿抗酸杆菌检查可作为初步筛查,B超,IVU,CT可作为首选影像学检查,CT在晚期肾结核诊断上更有优势,治疗以患肾加输尿管切除为主,应尽可能切除患侧输尿管全长,术后应抗结核治疗6个月或更长。 　　【关键词】肾结核;诊断;治疗 　　Diagnosis and Treatment of Advanced Renal Tuberculosis: 30 Cases Report 　　Sun HongWei 　　【Abstract】Objective : To explore the diagnosis and treatment of the advanced renal tuberculosis. Methods: The clinical data of 30 cases of advanced renal tuberculosis were analyzed retrospectively. Results: Irritation symptoms,gross hematuria and flank pain were found in 18 cases(60%) , 8 cases (26.7%) and 6 cases(20%), repectively. Abnormal urine test and acid positive fast stains on urinary sediment were detected in 28 cases(93.3%)and 8 cases(26.7%). The diagnost ic accuracy of B type ultrasonography, IVU and CT in these patients were 30 %, 53.3 % and 80%. 20 and 4 patients underwent nephrectomy and ureter-abdomen ostomy, respectively. Conclusion: B-type ultrasonography, IVU and CT are the of great importance in imaging diagnosis. Nephrectomy and partial ureterectomy is considered as the first choice of surgery after regular chemotherapy. 　　【Key words】 Renal tuberculosis ; Diagnosis ; Treatment 　　【中图分类号】R440【文献标识码】B【文章编号】1005-0515(2010)011-0082-02 　　 　　肾结核是结核分枝杆菌感染造成的结果,往往继发于肺结核、胃肠道结核等,近年来,由于肺结核疫情增多和结核耐药菌株的出现,肾结核发病率有回升趋势,且临床症状多不典型,给诊断造成很大困难,延误了治疗。我院于1999年10月~2009年8月共收治双肾结核伴双肾积水患者30例,现将分析结果报告如下。? 　　1 资料与方法 　　1.1 一般资料: 本组30例,男17例,女13例,年龄27~68岁,平均39岁。合并肺结核9例,肠结核2例,生殖器结核7例。伴下尿路刺激症状18例(60%),血尿8例(26.7%),腰痛6例(20%)。所有患者均行尿常规,尿抗酸杆菌,B超,IVU,CT检查,其中尿常规异常28例(93.3%),尿抗酸杆菌培养阳性8例(26.7%),B超显示肾积水22例(73.3%),其中双肾积水5例(16.7%),诊断肾结核9例(30%),IVU确诊16例(53.3%),CT确诊24例(80%)。 　　1.2 治疗方法: 本组中有6例因身体情况差,双肾结核等原因不能耐受手术而行保守治疗,治疗方案为异烟肼+利福平+吡嗪酰胺,3个月后停吡嗪酰胺改乙胺丁醇继续治疗,总疗程1~1.5年,平均1年2个月。24例采用手术治疗,术前均抗结核2~3周,20例术式为肾及输尿管切除术,术中尽可能切除输尿管全长,以减少术后输尿管残端过多,造成规律抗结核治