中晚期肾结核的诊断和治疗（附245例报告）

目的：探讨中晚期肾结核的诊断和治疗.方法：回顾性分析手术治疗的245例中晚期肾结核患者的临床资料：尿频、尿急、尿痛、腰痛和血尿是最常见的症状,分别为55.5%、41.2%、29%、31.8%和53.8%;IVP、B超、CT、膀胱黏膜活检和MRU诊断符合率分别为30.2%,57.1%,89.8%,29.1%和85.6%.手术治疗245例,其中肾切除210例,一侧肾切除对侧输尿管再植21例,挛缩膀胱行乙状结肠膀胱扩大术9例,双肾结核肾积水肾功不全5例行肾造瘘.结果：245例患者中,治愈238例,未愈7例,治愈率97.1%.结论：尿液检查、IVP、膀胱镜检查及黏膜活检对肾结核早期诊断有十分重要的意义.B超、CT、MRU对中晚期肾结核诊断有决定意义.中晚期肾结核需手术治疗.     

肾结核281例分析

目的　探讨临床肾结核的早期诊断和治疗。　方法　回顾性分析 2 81例肾结核患者的临床资料。　结果　膀胱刺激征、血尿和腰痛是最常见的临床症状。尿查抗酸杆菌、聚合酶链反应结核菌 (PCR TB DNA)和血清抗结核特异性抗体 (PPD IgG)检查阳性率分别为 42 .7%、44 .1%和6 2 .5 % ;IVU、B超、CT的诊断阳性率分别为 6 9.1%、2 8.3%、84.3%。 12 8例药物 (异烟肼 利福平 吡嗪酰胺三联治疗 ,6～ 8个月 )治疗者中 10 5例获痊愈 ,15 3例手术治疗者中 145例 (94.8% )施行患侧肾输尿管联合切除术。　结论　联合实验室检查可使临床不典型肾结核的诊断阳性率得到较大提高。IVU仍然是肾结核诊断的首选影像学检查 ,CT对可疑病例有一定的辅助诊断价值。早期肾结核短程三联治疗效果满意。肾结核肾切除应尽可能切除患侧输尿管。     

中晚期肾结核36例的临床特征

目的:探讨中晚期肾结核的临床特征.方法:报告36例中晚期肾结核患者的临床资料.均无典型临床表现;尿抗酸杆菌阳性率为19.4%;B超、IVU、和CT诊断符合率分别为30.6%、36.7%、81.2%.26例肾脏已无功能行手术切除(开放性手术20例,腹腔镜手术6例);10例行抗结核保守治疗,其中5例置双J管引流.结果:31例痊愈,5例失访.结论:肾结核的临床表现不典型、治疗不及时是导致中晚期肾结核发生的主要原因;CT对中晚期肾结核的诊断最有价值;治疗以肾切除术为主,术中应尽可能切除患侧输尿管;腹腔镜手术可以列为首选的治疗方法.     

肾结核101例影像学分析

目的 探讨中晚期肾结核的影像诊断方法.方法 分析并比较静脉肾盂造影(IVP)、B超、CT的影像资料.结果 腰痛、尿频、尿痛、尿急和血尿是最常见的临床症状,分别为65%、41%、35%、30%和22%.对于中晚期肾结核的诊断符合率:IVP为69.1%,B超为46.6%,CT为89.8% 结论B超对肾结核的诊断缺乏特异性,...     

肾结核的早期诊断与治疗

目的 探讨肾结核的早期诊断和治疗方法.方法 回顾性分析96例早期肾结核患者的临床资料.男58例,女38例.年龄17～52岁,平均34岁.病程2～22个月,平均10个月.右侧42例,左侧54例.合并附睾结核12例,肺结核28例.96例均行常规实验室及影像学检查.均行药物治疗,无效者行肾切除.结果本组血尿、尿频、尿急、尿痛和腰痛是肾结核最常见的症状,分别占67.7%(65/96)、54.2%(52/96)、43.7%(42/96)、37.5%(36/96)和22.9%(22/96).KUB+IVU、B超、CT、膀胱黏膜活检诊断符合率分别为67.7%、12.5%、37.5%、33.3%.96例采用抗结核药物[异烟肼(INH)+利福平(RFP)+乙胺丁醇(EMB)或吡嗪酰胺(PIA)]治疗6～8个月,临床治愈38例(39.1%),好转43例(44.8%).15例药物治疗无效者改行肾切除.结论尿液检查、IVU、膀胱镜检查及黏膜活检对肾结核早期诊断有十分重要的意义.INH+RFP+EMB或PIA三联治疗早期肾结核效果满意.     

肾结核540例诊治分析

目的 提高临床肾结核的诊断及治疗水平.方法 总结1980年至2005年540例肾结核患者的临床资料.男 303例,女237例.发病年龄10～69岁,其中20～40岁364例(67.4%).病程6周～18年.主要症状为尿频、尿急、尿痛、脓尿和血尿,男性患者中症状不典型12例.尿抗酸杆菌检查276例、尿TB-PCR检查56例、IVU检查384例、B超检查379例、CT检查389例、膀胱镜检查158例.结核发生于左肾251例,右肾262例,双肾结核27例.合并男生殖系结核132例,继发男性结核性尿道狭窄18例,女性同时有结核性膀胱阴道瘘11例.一侧肾结核并发对侧肾积水74例.长程药物治疗84例,包括一侧肾结核57例和双肾结核27例;短程药物治疗后行患侧肾及部分输尿管切除456例,就诊时一侧肾结核对侧肾积水伴肾功能不全44例先行积水侧肾造瘘,肾功能改善后行结核肾切除,患侧肾切除术后发生肾功能不全4例,二次手术行肾造瘘.11例行狭窄段输尿管切除后膀胱再植术,挛缩性小膀胱致肾积水38例中行回肠膀胱扩大术27例、乙状结肠膀胱扩大术9例、膀胱再生术2例.其中7例患者拒绝再次手术,长期留置肾造瘘管.结果 尿抗酸杆菌阳性24.6%(68/276)、尿TB-PCR阳性57.1%(32/56);IVU诊断肾结核141例(36.7%)、患侧肾脏未显影227例(59.1%)、显示肾自截16例(4.2%);B超诊断肾结核156例(41.2%)、肾积水166例(43.8%)、多囊肾或肾囊肿21例(5.5%)、肾脏无明显异常36例(9.5%);CT诊断肾结核344例(88.4%).随访6个月～25年.药物治疗组12例一侧肾结核患者(19.1%)在6～12个月后无效或恶化,改行患肾切除,其余45例药物治疗后18～24个月尿液检查正常,IVU显示病灶稳定或消失.双肾结核患者27例死于肾功能衰竭4例,12例改行一侧肾切除(其中5例加行对侧肾部分切除),余11例随访结核病灶稳定或缩小,肾功能正常.结论 临床肾结核的发生率无明显下降,而肾结核的并发症明显降低,非手术治愈率显著增加.尿TB-PCR和IVU为早期肾结核的诊断方法.     

不典型肾结核29例临床分析

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。     

肾结核72例临床分析

目的　提高肾结核的诊治水平。方法　回顾性分析72例肾结核的临床资料,总结其诊治经验。结果　尿沉渣涂片找抗酸杆菌和尿PCR TB DNA阳性率分别为22%和72.2%。72例均接受手术治疗,术后病理均诊断为肾结核。结论　泌尿系结核的临床诊断应综合分析,影像学检查及病原学诊断等多种方法,力求寻找更多证据。X线检查应首选静脉肾盂造影和逆行肾盂造影,对两者未能明确诊断者,可选择CT检查。     

多层螺旋CT尿路造影在肾结核诊断中的应用价值

目的 探讨多层螺旋CT尿路造影(CTU)在肾结核诊断中的应用价值.方法 经术后病理证实的肾结核患者30例.男16例,女14例.平均年龄44(19～73)岁.左肾结核17例,右肾结核13例.临床表现尿路刺激症状者18例、腰痛18例、血尿6例、发热者2例、体检偶然发现2例、左阴囊肿大为主要症状者1例.术前均采用螺旋CT薄层增强扫描及三维重建技术诊断,评估CTU检查的应用价值.结果 30例患者中,CTU诊断肾结核29例(97%).其中肾实质内多发囊性低密度灶肾盂无扩张积液25例,结核钙化18例,肾盂输尿管管壁增厚、输尿管管腔狭窄17例,肾皮质变薄12例,膀胱挛缩充盈不良2例.IVU诊断肾结核9例(30%),肾盂、肾盏未能显影20例.1例CTU示左输尿管下段结石、左肾盂及输尿管扩张积液,IVU示左输尿管结石、左肾积水,术后病理检查证实左肾结核.结论 CTU具有快速薄层扫描、容积重建及图像后处理功能,对于中晚期IVU 不显影的肾结核有较高的诊断价值.     

肾结核的诊断与治疗

目的 探讨肾结核的发病特点,提高肾结核的诊断和治疗水平. 方法 1993至2007年收治肾结核患者223例.分析患者年龄分布、临床症状、影像学检查特点及其治疗情况. 结果 223例发病年龄20～40岁93例(41.7%),41～54岁81例(36.3%).病程1 d～30年,平均38.5个月.首诊时诊断为肾结核仅36例,187例有1次或多次误诊,最常见的误诊为尿路感染,占50.3%(94/187).临床表现以血尿(131例,58.7%)、尿频(122例,54.7%)、尿急(112例,50.2%)、尿痛(94例,42.2%)为主,同时存在≥3种症状者占58.3%(130/223).实验室检查尿找抗酸杆菌阳性率41.9%(65/155).221例行KUB加IVU检查,有典型肾结核影像学表现者79例(35.7%).223例行B超检查,考虑有肾结核病灶者161例(72.2%).104例行CT检查,考虑有肾结核病灶者79例(76.0 0%).首选手术治疗173例(77.6%),其中行患肾切除手术136例(78.6%)、行肾部分切除术或局部病灶清除术37例(21.4%).2例因尿毒症行透析治疗.48例(21.5%)明确诊断后门诊行抗结核药物治疗,临床治愈41例(85.4%),转行患肾切除手术7例(14.6%). 结论 肾结核患者发病趋于不典型化,临床遇到有尿路感染症状者,尤其是久治不愈的尿路感染患者,应警惕肾结核的可能.     

92例肾结核临床分析

目的：探讨肾结核诊断与治疗。方法：对92例肾结核患者的诊断及治疗进行回顾性分析。结果：尿沉渣涂片找抗酸杆菌、尿聚合酶链反应结核菌（PCR-TBDNA）和血清抗结核特异性抗体（PPD-IgG）的阳性率分别为15．8％、53．8％和15．1％。B超、IVu、CT和磁共振尿路成像（MRU）阳性率分别为18．8％、48．9％、79．1％和81．0％。单纯抗结核药物治愈22例，开放肾切除术45例，后腹腔镜肾切除术25例。术中失血量、术后住院口及术后卧床时间比较，后腹腔镜组明显少于开放手术组。结论：对不典型肾结核的甲期诊断需提高认识，重视病史。聚合酶链反应结核菌、CT和MRU在肾结核诊断中起着越来越重要的作用。早期肾结核患者行三联化疗有效。晚期肾结核行肾输尿管切除术十分重要，后腹腔镜肾切除术是无功能结核肾理想的外科治疗方法。     

磁共振水成像结合常规磁共振检查在泌尿系肿瘤诊断中的价值

目的 探讨磁共振水成像(MRU)及常规磁共振(MRI)在泌尿系肿瘤诊断中的价值.方法 回顾性分析我院23例泌尿系肿瘤患者,其中输尿管癌8例,肾盂癌4例,膀胱癌6例,输尿管转移瘤4例,肾癌1例.23例患者均行MRU及常规MRI检查,其中8例患者行静脉肾盂造影(KUB+IVP)检查,8例患者行CT+CTU检查.分析23例患者的IVP、CTU和MRU,并与手术后病理结果相对照.结果 23例患者通过MRU并结合常规MRI可以从不同角度清楚描述泌尿系肿瘤的各种异常影像改变,定位诊断正确率为100％ (23/23),定性诊断正确率为95.6％ (22/23).8例患者的IVP定位诊断率50％ (4/8),定性诊断率37.5％ (3/8).8例CTU患者的定位诊断率100％ (8/8),定性诊断率为75.0％ (6/8).结论 MRU结合常规MRI定位定性诊断正确率高,无创且不受肾功能影响,可作为泌尿系肿瘤诊断的重要检查手段.     

不典型泌尿系结核的诊治(附23例报告)

目的：探讨肾结核的诊断与治疗方法。方法：回顾性分析23例肾结核患者的临床资料,将不典型泌尿系结核分为七类。结果：除膀胱刺激征、血尿等最常见的症状外,泌尿系结核的临床症状越来越不典型。除肾功能尚好的6例采用联合服药治疗,2例随访治愈外,余17例行患肾及输尿管切除术,术后病理检查诊断为肾结核。6例获得随访,2例并发结核性小膀胱,2例并发输尿管残端综合征,2例痊愈。结论：静脉肾盂造影（IVP）是肾结核首选的有诊断意义的检查方法,对不典型肾结核的诊断需要在提高认识的同时重视病史,综合分析尿细菌学及IVP检查,必要时联合逆行肾盂造影（RP）、CT检查才能确诊。个别患者只有在手术时才能确诊。强调晚期肾结核行半尿路全切除术十分重要;肾功能尚好的早期肾结核患者行三联化疗是有效的。     

A prospective analysis of 1,930 patients with hematuria to evaluate current diagnostic practice

PURPOSE: The commonly accepted diagnostic algorithm for hematuria includes excretory urography (IVP) and cystoscopy. Some have suggested that ultrasound of the upper urinary tract is adequate and that cystoscopy is not necessary in younger patients with microscopic hematuria. We ascertain whether a less intensive algorithm could be adopted while retaining diagnostic efficacy. MATERIALS AND METHODS: A total of 1,930 patients were enrolled prospectively in the study at a hematuria clinic between October 1994 and March 1997. Evaluation consisted of basic demographics, history and examination, routine blood tests, urinalysis and cytology. All patients underwent plain abdominal radiography, renal ultrasound, IVP and flexible cystoscopy. RESULTS: A total of 1,194 males and 736 females with a mean age of 58 years (range 17 to 96) were included in the study. Overall, 61% of patients had no basis found for hematuria, 12% had bladder cancer, 13% had urinary tract infection and 2% had stones. Kidney and upper tract tumors were noted in 14 patients (0.7%), including 4 who presented with microscopic hematuria. If only ultrasound or IVP had been performed 4 of these cases would have been missed. Of 982 patients presenting with microscopic hematuria 51 had cancer. Bladder cancer was found in 7 patients younger than 40 years. CONCLUSIONS: Our findings suggest that cystoscopy cannot be safely avoided even in younger patients with microscopic hematuria. Only a combination of ultrasound and IVP detected all upper tract tumors.     

The effect of intravesical bacillus Calmette-Guerin therapy on the upper urinary tract

A total of 66 patients with low grade, low stage transitional cell carcinoma of the bladder who were treated with intravesical bacillus Calmette-Guerin (BCG) underwent cystourethrography to detect vesicoureteral reflux. BCG was instilled weekly for 6 weeks and monthly thereafter for up to 24 months. Whenever vesicoureteral reflux was found or morphological abnormalities were detected on excretory urography (IVP) an isotope renal scan was performed to evaluate the relative renal function. Vesicoureteral reflux was found in 13 patients (19.7%): 10 had grades 1 and 2A, and 3 had grade 2B reflux. The number of BCG instillations ranged from 8 to 22. IVPs were normal in 11 patients. In 2 patients mild unilateral dilatation was present before BCG instillations, and this remained unchanged during and after therapy. None of the 13 patients with vesicoureteral reflux had IVP features suggestive of urinary tuberculosis. In 11 patients the refluxing renal systems had normal relative renal function (50 to 55%). Two patients had a decrease to 40% of the relative renal function with normal IVPs, suggesting a nonBCG related cause. We conclude that BCG therapy is safe in patients with minimal reflux.     

Value of selective upper tract cytology for recognition of upper tract tumors after treatment of superficial bladder cancer

Background: The value of selective upper urinary tract (UT) cytology in patients who are asymptomatic and tumor free at control cystoscopy after being treated for superficial bladder carcinoma has not been studied. The present study was performed to evaluate the value of selective UT cytology in patients who are tumor free at control cystoscopy after being treated for superficial bladder cancer. Methods: Forty‐seven consecutive patients who had undergone definitive surgical treatment for superficial bladder cancer at least 24 months prior and were tumor free at control cystoscopy were evaluated with bladder wash for cytology as well as selective UT urine cytology by catheterization of both ureteral orifices. Of the 47 patients, disease was stage Ta in 30 (63.8%), T1 in 15 (31.9%) and Ta/Tcis in 2 (4.3%). Primary tumor was unifocal in 24 (51.1%) and multifocal in 23 (48.9%) patients. The time elapsed from the initial diagnosis to the last evaluation ranged from 2 to 21 years (mean 5.39). Results: UT cytology was positive in 2 cases. Although, excretory urography (IVP) revealed mild pelvicalicectasis in 1 of these 2 patients, ureterorenoscopy (URS) revealed no abnormality. In the other patient with normal IVP and retrograde pyelography (RGP), URS revealed a ureteral tumor 5 mm in diameter. Although the UT cytology was normal in the remaining 45 patients, IVP revealed right hydronephrosis in 1 patient and URS revealed multiple ureteral tumors. Conclusion: Given the normal appearance of the UT, it is highly unlikely that these patients have tumor in the UT. Thus, during the follow‐up of patients with superficial bladder cancer, it is not useful to perform UT select cytology in the absence of any identifiable filling defects in the upper urinary tract.     

肾结核的术前诊断

目的 提高肾结核的术前诊断率。方法 回顾性分析180例手术治疗的肾结核患者的临床资料。结果 膀胱刺激征、血尿和腰痛是最常见的临床症状,无症状的肾结核所占比例为6.1％。尿查抗酸杆菌阳性率为12.4％。IVP、B超、CT、CTU的诊断阳性率分别为23.5％、75％、85.6％、95.3％。误诊肾结石6例,误诊肾积水4例。...     

Significance of atypical urinary cytology in the evaluation of patients with end‐stage renal disease for kidney transplantation – a retrospective study

To determine what percentage of renal transplant candidates have atypical urinary cytology, what proportion have urothelial carcinoma and whether cystoscopy is necessary with atypical cytology. All end‐stage renal disease (ESRD) patients (703) presenting for renal transplantation at our institution were retrospectively reviewed. Individuals producing sufficient urine were screened with urine cytology and those with atypical cytology or risk factors for bladder cancer underwent cystoscopy. Four hundred and thirty patients had available urinary cytology and, of these, 151 (35%) had atypical cytology. Of patients with atypical cytology, three were identified to have urothelial carcinoma. However, three additional patients with urothelial carcinoma did not present with atypical cytology. In total, 6 of 703 (0.85%) patients had bladder cancer. All were treated with transurethral resection and eventually underwent renal transplant. One patient has had disease progression post‐transplant to distant metastases. This is the largest study to date evaluating the incidence of urothelial carcinoma in ESRD patients presenting for transplant workup. We found the incidence of bladder cancer to be higher than in the general Canadian population, however, most lesions were low grade. We found atypical cytology in transplant candidates to be a poor predictor for these low‐grade lesions and do not recommend routine cystoscopy for atypical cytology.