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目的 :提高肾结核诊治水平。方法 :回顾性分析了 32例肾结核的诊治经过。结果 :临床症状不典型者 14例 (43.8% )。尿抗酸杆菌阳性占 34 .4% (11/ 30例 ) ;IVU检查 30例 ,典型结核改变 11例 (36 .7% ) ;逆行尿路造影及CT各 11例 ,诊断肾结核分别为 3例 (2 7.3% )和 6例 (5 4.5 % ) ;手术治疗 2 8例 ,肾切除 2 7例 ,回肠膀胱术 1例 ,附睾切除 1例 ,因误诊行前列腺摘除术 1例。术后随访 1～ 2年 ,1例膀胱挛缩、尿失禁拒绝再次手术。结论 :不典型肾结核是延误诊治的主要原因。尿沉渣查抗酸杆菌和IVU是主要诊断方法 ,CT对诊断不确切的肾结核价值较高。肾切除是中晚期肾结核的主要治疗方式。
Objective: To improve the diagnosis and treatment of renal tuberculosis. Methods: The diagnosis and treatment of 32 cases of renal tuberculosis were retrospectively analyzed. Results: Atypical clinical symptoms in 14 cases (43.8%). Positive urine acid-fast bacilli accounted for 34.4% (11/30 cases); IVU examination in 30 cases, typical tuberculosis change in 11 cases (36.7%); retrograde urography and CT in 11 cases, the diagnosis of renal tuberculosis were 3 (2 7.3%) and 6 cases (4.5%). Surgical treatment of 28 cases, 27 cases of nephrectomy, ileal bladder surgery in 1 case, epididymal resection in 1 case, misdiagnosis of prostatectomy in 1 case. Follow-up 1 to 2 years after surgery, 1 case of bladder contracture, urinary incontinence refused to re-operation. Conclusion: Atypical renal tuberculosis is the main reason for delayed diagnosis and treatment. Urine sediment check acid bacteria and IVU is the main diagnostic method, CT diagnosis of imprecise renal tuberculosis is of higher value. Nephrectomy is the main treatment for advanced renal tuberculosis.