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目的:探讨不典型肾结核的诊断和治疗。方法:回顾性分析29例不典型肾结核患者的临床资料:29例患者行尿常规、血沉(ESR)、抗结核抗体(TB-Ab)实验室检查以及B超、IVU、CT影像学检查;15例行异烟肼+利福平+吡嗪酰胺/乙胺丁醇药物治疗,14例行手术治疗。结果:尿常规、ESR、TB-Ab阳性率分别为55.17%、44.44%、50.00%,B超、IVU、CT诊断符合率分别为10.34%、28.57%、68.97%;14例术后病理检查均符合典型结核病变,15例药物治疗者均治愈,14例手术治疗者随访6个月~2年均治愈。结论:B超检查适用于门诊筛选和术后复查。CT和IVU对不典型结核诊断价值很高。实验室联合影像学检查可提高诊断效率。早期肾结核可行药物治疗,中晚期肾结核以肾切除为主,切除范围尽量包括肾周脂肪及严重病变的输尿管。
Objective: To investigate the diagnosis and treatment of atypical renal tuberculosis. Methods: The clinical data of 29 patients with atypical renal tuberculosis were analyzed retrospectively. Twenty-nine patients underwent routine laboratory tests of ESR, TB-Ab and B-ultrasound, IVU and CT. 15 cases of isoniazid + rifampicin + pyrazinamide / ethambutol drug treatment, 14 cases were treated surgically. Results: The positive rates of urinary routine, ESR and TB-Ab were 55.17%, 44.44% and 50.00%, respectively. The diagnostic rates of B-ultrasound, IVU and CT were 10.34%, 28.57% and 68.97% In line with the typical tuberculosis, 15 cases of drug treatment were cured, 14 cases of surgical treatment were followed up for 6 months to 2 years were cured. Conclusion: B-ultrasound is suitable for clinic screening and postoperative review. CT and IVU diagnosis of atypical tuberculosis is of high value. Laboratory joint imaging improves diagnostic efficiency. Early renal tuberculosis feasible drug treatment, mainly in the late nephrectomy renal tuberculosis, resection range as much as possible, including perirenal fat and serious lesions of the ureter.