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目的探讨肾结核的诊断和治疗方法。方法对45例肾结核患者进行回顾性分析。结果尿路刺激症状和血尿为常见症状,分别为88.8%和48.0%。尿沉渣检查抗酸杆菌阳性12例(26.7%),同期尿结核杆菌PCR(TbPCR)检查35例,阳性20例(57.1%)。静脉肾盂造影(IVU)检查43例,异常改变者40例(93.0%);B超确诊16例(35.6%);CT确诊31例(88.6%)。误诊为结石或炎症23例。药物治疗9例(20.0%),手术治疗36例(80.0%)。9例药物治疗均痊愈;36例行手术治疗,手术后病理均诊断为肾结核。结论尿沉渣染色查抗酸杆菌仍重要,尿TbPCR检查是术前确诊肾结核的主要手段。IVU和B超可作为泌尿系结核诊断首选的影像学检查。首选术式为肾及部分输尿管切除术。
Objective To investigate the diagnosis and treatment of renal tuberculosis. Methods 45 cases of renal tuberculosis were retrospectively analyzed. Results Urinary tract irritation and hematuria were common symptoms, 88.8% and 48.0% respectively. 12 cases (26.7%) were positive for acid-fast bacilli in urine sediment test, 35 cases were positive for TB PCR in the same period, and 20 cases were positive (57.1%). 43 cases were diagnosed by intravenous pyelography (IVU), 40 cases (93.0%) with abnormal changes, 16 cases (35.6%) were diagnosed by B ultrasound, and 31 cases (88.6%) were diagnosed by CT. Misdiagnosed as stones or inflammation in 23 cases. Nine patients (20.0%) were treated with drugs and 36 patients (80.0%) were treated surgically. Nine cases of drug treatment were cured; 36 cases of surgical treatment, postoperative pathology were diagnosed as renal tuberculosis. Conclusion Urinary sediment stain check acid-fast bacilli is still important, urine TbPCR examination is the main means of preoperative diagnosis of renal tuberculosis. IVU and B ultrasound can be used as the preferred imaging diagnosis of urinary tuberculosis. The preferred surgical technique is partial nephrectomy and ureter.