外科学教学课件：泌尿、男生殖系统结核.pptVIP

Diagnosis ： 临床表现+肛诊 尿查抗酸杆菌，尿培养 尿道造影 Differential diagnosis: 前列腺炎 前列腺癌 附睾炎 睾丸肿瘤 Treatment: Prostate, seminal vesicle tuberculosis: drug treatment Epididymal tuberculosis: light: drug therapy; ?????????Abscess or sinus formation: Drug and surgery Thank you! 泌尿、男生殖系统结核(Genitourinary tuberculosis ) outline 1、Overview of genitourinary tuberculosis 2、 Pathology transfer process and pathological changes of genitourinary tuberculosis. 3、 Clinical manifestations 4、 Diagnosis, differential diagnosis 5、 Treatment 6、 The male reproductive system tuberculosis Genitourinary tuberculosis Lung tuberculosis （mainly）、bone and joint tuberculosis →Renal tuberculosis → Ureter TB、 bladder TB、 Urinary TB → male reproductive system tuberculosis（epididymal TB） Symptoms of genitourinary tuberculosis：3-10 years or longer after Lung tuberculosis Pathology transfer process and pathological changes TB→Blood→Kidney→ Renal cortex → Multiple small tubercle→ Self-healing→ Pathological renal tuberculosis or→ tubercle progression→ Medulla tuberculosis→ Renal pelvis→ Clinical renal tuberculosis Kidney disease ：多发结核结节→干酪样脓肿→空洞溃疡→累及全肾→纤维化、钙化→肾自截（autonephrectomy） Ureteral lesions ：粘膜或粘膜下结核结节、溃疡、肉芽肿、纤维化、管腔节段性狭窄 左肾自截 Bladder disease ：粘膜充血水肿，结核结节→纤维化、瘢痕形成→挛缩膀胱（contracted bladder）容量＜50ml→健侧输尿管口狭窄→健侧肾积水（肾结核的晚期并发症） Urinary tuberculosis ：结核性溃疡、纤维化→尿道狭窄 Clinical manifestations Renal tuberculosis：20-40 male， Unilateral 90% 1, urinary frequency, urgency, dysuria – 典型症状 2, hematuria, mostly terminal hematuria – 重要症状 3, pyuria – 常见症状 4, back pain and lumps：多无腰痛，梗阻、脓肾、继发感染时可有腰痛。肾积脓巨大或巨大肾积水可触及肿块。 5, male reproductive system tuberculosis：男性50-70%合并生殖系结核，附睾结核最常见：附睾不规则硬块，输精管串珠样改变。 6, systemic symptoms：发热、盗汗、消瘦、贫血、慢性肾功能不全等。 Diagnosis, differential diagnosis History ：青壮年男性，慢性膀胱炎，尿培养无菌，抗菌治疗无效，附睾病变 Urine tests ：酸性，尿蛋白（+），晨尿沉渣查抗酸杆菌（50-70%，至少三次），尿培养查抗酸杆菌（4-8周，90%）。 Imaging: B-Ultrasound ：中晚期病例，肾结构紊乱，肾积水 X-ray ：KUB：钙化 IVU：分肾功能检查，虫蚀样空洞 Retrograde angiography ：管壁僵硬，狭窄，空洞 CT和MRI： 中晚期结核，IVU不佳