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目的总结不典型肾结核的诊断与治疗经验。方法回顾性分析56例不典型肾结核患者的临床资料。结果 56例患者临床表现为尿路刺激征38例,腰痛34例,血尿32例;尿常规异常51例(91.1%),尿沉渣找抗酸杆菌(AFB)阳性率26.1%,血清抗结核特异性抗体(PPD-lgG)阳性率51.2%,尿聚合酶链反应结核菌(PCR-TB-DNA)阳性率61%。泌尿系影像学检查:即B超,KUB+IVU,CT,MRU阳性率分别为21.4%,51.8%,80.4%,75%,单纯使用抗结核化疗治愈12例,手术治疗44例,其中开放手术39例,腹腔镜手术5例。结论不典型肾结核临床表现缺乏特异性,实验室与影像学检查对确诊肾结核有决定性意义,规范的抗结核药物治疗是治疗早期肾结核的有效方法,中晚期肾结核则必须行手术治疗。
Objective To summarize the experience of diagnosis and treatment of atypical renal tuberculosis. Methods The clinical data of 56 patients with atypical renal tuberculosis were retrospectively analyzed. Results The clinical manifestations of 56 patients were 38 cases of urinary tract irritation, 34 cases of low back pain, 32 cases of hematuria, 51 cases of abnormal urinalysis (91.1%), 26.1% of AFB (urinary sediment) The positive rate of PPD-IgG was 51.2% and the positive rate of PCR-TB-DNA was 61%. Urology imaging examination: The positive rates of B ultrasound, KUB + IVU, CT and MRU were 21.4%, 51.8%, 80.4% and 75% respectively. Twelve cases were treated with anti-tuberculosis chemotherapy alone and 44 cases were treated by open surgery 39 cases, laparoscopic surgery in 5 cases. Conclusions The clinical manifestations of atypical renal tuberculosis are not specific. Laboratory and radiological examination are of decisive significance for the diagnosis of renal tuberculosis. Standardized antitubercular drug therapy is an effective treatment for early stage renal tuberculosis. Late stage renal tuberculosis must be treated surgically.