伴有临床症状的重复肾重复输尿管畸形诊断要点分析

目的:探讨重复肾输尿管畸形诊断方法,提高诊断水平.方法:回顾性分析2003～2007年39例确诊为重复肾输尿管畸形的病例资料,根据就诊时有无重复肾输尿管畸形所致临床症状,分为症状组和无症状组.结果:症状组23例,无症状组16例.症状组常见的临床症状分别为:腰腹部胀痛或包块14例(60.9%),漏尿7例(30.4%),反复发热6例(26.1%),膀胱刺激征4例(17.4%).症状组辅助检查诊断率分别为:超声91.3%(21/23),静脉肾盂造影(IVP)61.1%(11/18),磁共振泌尿系水成像(MRU)81.8%(9/11).对于症状组病例肾盂输尿管梗阻积水原因诊断:超声检查发现输尿管下段狭窄1例,逆行肾盂造影发现肾盂输尿管交界处狭窄2例,MRU发现输尿管下段狭窄3例和肾盂输尿管交界处狭窄2例.结论:对于重复.肾输尿管畸形的诊断,临床表现结合超声、IVP检查几乎对所有病例均可明确诊断,MRU并无明显优势;对于重复肾输尿管积水原因的诊断,逆行肾盂造影和MRU要优于超声和IVP.     

CT尿路成像和IVU检查诊断泌尿系统疾病的比较研究

目的 比较CT尿路成像(CTU)和IVU检查诊断泌尿系统疾病的准确率,探讨临床上CTU取代IVU的可能性.方法 CTU检查泌尿系统疾病患者165例.男111例,女54例.平均年龄42(18～71)岁.肾输尿管结石75例、肾盂输尿管连接处畸形30例、膀胱癌30例、肾盂旁囊肿和肾盂源性囊肿15例、双侧巨输尿管症9例、肾盂输尿管肿瘤6例.行IVU和CTU检查78例,行CTU、IVU和逆行肾盂输尿管造影(RP)检查12例,行CTU和RP检查24例,仅行CTU检查51例.结果 165例患者中,CTU和IVU检查诊断准确率分别为94.5%(156/165)、46.7%(42/90),二者比较差异有统计学意义(P＜0.01).二者诊断上尿路结石准确率分别为100.0%(75/75)、78.6%(33/42)(P＜0.05);CTU诊断肾盂输尿管连接部畸形准确率为90.0%(27/30),IVU检查15例仅能显示肾盂积水;CTU诊断膀胱癌准确率为100.0%(30/30),IVU检查12例,发现膀胱内充盈缺损9例(75%)(P>0.05)CTU诊断肾盂旁囊肿和肾盂源性囊肿准确率为80.0%(12/15),IVU检查10例无法显示囊肿范围与大小;CTU诊断双侧巨输尿管症准确率为100.0%(9/9),IVU检查6例仅发现患侧肾脏不显影或肾盂积水;CTU诊断输尿管恶性肿瘤准确率为100%(6/6),IVU检查5例仅发现患侧肾脏不显影或肾盂积水.CTU和IVU对上尿路梗阻性病变者患侧和(或)梗阻远端显示率分别为79.4%(81/102)、25.0%(15/60),二者比较差异有统计学意义(P＜0.01).CTU、IVU检查时间分别为(18.9±8.4)、(67.1±26.7)min,二者比较差异有统计学意义(P＜0.01).结论 CTU检查在诊断泌尿系统疾病准确率、了解病变周围组织情况以及对梗阻远端尿路显示率方面明显优于IVU检查,在大部分情况下可以取代IVU检查成为常规方法之一.     

成人中胚层肾瘤1例

患者,女,55岁.体检时B超发现肾盂肿物1个月入院.无血尿病史.体检:体温36.8℃,脉搏84次/分,呼吸20次/分,血压120/80 mmHg(1mmHg=0.133 kPa),心肺无特殊;腹软,未触及肿块,肾区无叩痛.辅助检查:尿脱落细胞检查3次均未发现肿瘤细胞.B超示右肾盂肿物直径约2cm,中等回声;腹部平片加肾盂静脉造影发现右肾盂有占位性病变;膀胱镜逆行造影检查见膀胱无异常,右肾中盏有占位性病变;CT示右肾盂有占位性病变.入院诊断:右肾盂占位性病变.因患者家属有肾肿瘤病史,患者坚决要求手术切除.于2003年1月3日行单纯右肾切除术.术后大体标本病理切片镜下见肿瘤组织以平滑肌为主,平滑肌间散在上皮细胞围成的管状结构,部分上皮呈低柱状及立方状,部分似宫内膜样腺体(图1),ER、PR平滑肌阳性.诊断为中胚层肾瘤(右肾).酶标(S2003-N105):SMA( ),MSA( ),CD34(-),CK7( ),Vim( ),ER( ),PR( ).术后随访2年,患者健康.     

减少肾盂癌术后再发膀胱癌的临床研究

目的 探讨减少肾盂癌术后再发膀胱癌的方法.方法 回顾性分析1997年10月至2007年12月收治并获随访的227例肾盂癌患者.男性126例,女性101例,年龄34～78岁.全程肉眼血尿176例,腰部疼痛51例.采用两种方法分离患侧管口周围膀胱壁.A方法:沿患侧输尿管分离至膀胱壁;B方法:沿输精管向下分离患侧管口周围膀胱后壁并切断膀胱侧韧带达精囊部位.采用三种方法进行膀胱灌注化疗.方法 1:术后当天开始每周灌注1次,共10次;方法2:术后当天灌注1次,3周后每周灌注1次,共10次;方法3:术后3周开始每周灌注1次,共10次.术后定期膀胱镜检查,随访1～10年.采用χ2检验和Logistic回归对膀胱癌再发率进行分析.结果 术后膀胱癌再发率27.8%(63/227).采用方法A和方法B的患者患侧管口周围区域膀胱癌再发率分别为18.0%(7/39)和12.5%(3/24),两者相比较差异有统计学意义(P<0.05).膀胱灌注化疗方法1、2、3的膀胱癌再发率分别为17.9%(11/67)、20.8%(10/48)、33.3%(17/51),方法1与方法3相比较差异有统计学意义(P<0.05).结论 充分分离确切切除患侧管口周围膀胱黏膜,术后当日开始每周1次膀胱灌注化疗是减少肾盂癌术后再发膀胱癌的有效方法.     

首发为肺外表现的原发性肺癌29例分析

目的:通过分析以肺外表现为首发症状的原发性肺癌,以提高原发性肺癌的早期诊断.方法:总结245例原发性肺癌中以肺外表现为首发症状的29例病人的临床资料,观察其分布规律.对不同类型肺癌肺外表现的发生率做Fisher‘sExact Test.结果:本组资料显示:以肺外表现为首发症状的原发性肺癌发生率为11.4%(29/245).29例病人中表现为骨关节病变14例,神经肌肉病变12例,内分泌功能失调综合征3例.在不同类型肺癌中,发生率为:鳞癌9.5%(10/105),腺癌8.9%(7/79),小细胞癌22.5%(9/40),大细胞癌14.3%(3/21).结论:小细胞肺癌的肺外表现发生率明显高于鳞癌、腺癌(P＜0.05),与大细胞癌的发生率无明显差异(P＞0.05),其他类型之间无差异(P＞0.05).提高对原发性肺癌中的肺外表现的认识有助于原发性肺癌的早期诊断.     

肝脏局灶结节性增生的诊断和治疗

目的 探讨肝脏局灶结节性增生(focal nodular hyperplasia,FNH)的诊断和治疗方法.方法 对1997-2007年期间收治并经手术病理证实的32例FNH的临床资料进行回顾性分析.结果 32例病人中40岁以下占65.6%,男性多见(71.9%),多无临床症状(59.4%),AFP均为阴性.病灶多为单发(90.6%),平均直径3.0 cm(1.0～8.0 cm).术前B超诊断符合率仅为6.5%(2/31),增强螺旋CT诊断符合率45.5%(10/22),MRI诊断符合率80.0%(4/5).超声造影诊断符合率50.0%(2/4).结论 MRI和螺旋CT是诊断FNH的重要手段.结合多种影像手段,有助于提高FNH的诊断率.对诊断不明确或症状较为明显的,以及病灶进行性增大的病人应行手术切除.     

肝脏局灶结节性增生的诊断和治疗

目的 探讨肝脏局灶结节性增生(focal nodular hyperplasia,FNH)的诊断和治疗方法.方法 对1997-2007年期间收治并经手术病理证实的32例FNH的临床资料进行回顾性分析.结果 32例病人中40岁以下占65.6%,男性多见(71.9%),多无临床症状(59.4%),AFP均为阴性.病灶多为单发(90.6%),平均直径3.0 cm(1.0～8.0 cm).术前B超诊断符合率仅为6.5%(2/31),增强螺旋CT诊断符合率45.5%(10/22),MRI诊断符合率80.0%(4/5).超声造影诊断符合率50.0%(2/4).结论 MRI和螺旋CT是诊断FNH的重要手段.结合多种影像手段,有助于提高FNH的诊断率.对诊断不明确或症状较为明显的,以及病灶进行性增大的病人应行手术切除.     

肝脏局灶结节性增生的诊断和治疗

目的 探讨肝脏局灶结节性增生(focal nodular hyperplasia,FNH)的诊断和治疗方法.方法 对1997-2007年期间收治并经手术病理证实的32例FNH的临床资料进行回顾性分析.结果 32例病人中40岁以下占65.6%,男性多见(71.9%),多无临床症状(59.4%),AFP均为阴性.病灶多为单发(90.6%),平均直径3.0 cm(1.0～8.0 cm).术前B超诊断符合率仅为6.5%(2/31),增强螺旋CT诊断符合率45.5%(10/22),MRI诊断符合率80.0%(4/5).超声造影诊断符合率50.0%(2/4).结论 MRI和螺旋CT是诊断FNH的重要手段.结合多种影像手段,有助于提高FNH的诊断率.对诊断不明确或症状较为明显的,以及病灶进行性增大的病人应行手术切除.     

肝脏局灶结节性增生的诊断和治疗

目的 探讨肝脏局灶结节性增生(focal nodular hyperplasia,FNH)的诊断和治疗方法.方法 对1997-2007年期间收治并经手术病理证实的32例FNH的临床资料进行回顾性分析.结果 32例病人中40岁以下占65.6%,男性多见(71.9%),多无临床症状(59.4%),AFP均为阴性.病灶多为单发(90.6%),平均直径3.0 cm(1.0～8.0 cm).术前B超诊断符合率仅为6.5%(2/31),增强螺旋CT诊断符合率45.5%(10/22),MRI诊断符合率80.0%(4/5).超声造影诊断符合率50.0%(2/4).结论 MRI和螺旋CT是诊断FNH的重要手段.结合多种影像手段,有助于提高FNH的诊断率.对诊断不明确或症状较为明显的,以及病灶进行性增大的病人应行手术切除.     

肝脏局灶结节性增生的诊断和治疗

目的 探讨肝脏局灶结节性增生(focal nodular hyperplasia,FNH)的诊断和治疗方法.方法 对1997-2007年期间收治并经手术病理证实的32例FNH的临床资料进行回顾性分析.结果 32例病人中40岁以下占65.6%,男性多见(71.9%),多无临床症状(59.4%),AFP均为阴性.病灶多为单发(90.6%),平均直径3.0 cm(1.0～8.0 cm).术前B超诊断符合率仅为6.5%(2/31),增强螺旋CT诊断符合率45.5%(10/22),MRI诊断符合率80.0%(4/5).超声造影诊断符合率50.0%(2/4).结论 MRI和螺旋CT是诊断FNH的重要手段.结合多种影像手段,有助于提高FNH的诊断率.对诊断不明确或症状较为明显的,以及病灶进行性增大的病人应行手术切除.     

30例晚期肾结核患者诊断分析

目的：探讨晚期肾结核的发病原因及其诊断方法。方法：回顾性分析30例经病理学诊断的晚期肾结核患者的临床症状、实验室检查和影像学检查结果。结果：临床症状表现为膀胱刺激症状(90．00％)．血尿(66．67％)，腰痛(26．67％)。病程不超过半年者7例(23．33％)．其中5例患肾功能已丧失。实验室检查尿常规100％(30／30)结果异常．红细胞沉降率81．82％(18／22)异常升高．结核杆菌及其抗体检测阳性率偏低。静脉尿路造影57．14％(16／28)患侧不显影。B超检查均提示患肾积水、结构紊乱等改变。结论：肾结核临床症状不典型以及部分患者的早期隐匿无症状，是导致晚期肾结核发生的重要原因。肾结核的正确诊断首先有待于临床上对其临床特点及其不典型的变化趋势有足够的认识和警惕．其次是应对临床症状、实验室检查及影像学检查结果进行综合分析。     

不典型中晚期肾结核诊治分析(附14例报告)

目的：探讨不典型中晚期肾结核的临床表现及诊治方法。方法：回顾性分析14例不典型中晚期肾结核的临床资料。结果：14例患者主要表现为血尿、腰痛、尿频、肾积水。尿常规异常86％(12／14)，尿沉渣找抗酸杆菌阳性率33％(3／9)，尿TB-PCR阳性率25％(1／4)，静脉尿路造影患肾不显影57％(8／14)，CT确诊率80％(8／10)。1例行药物治疗，13例行手术治疗。14例随访1～4年均治愈．发生输尿管残端综合征1例。结论：临床症状不典型以及部分病例起病隐匿，是导致中晚期肾结核误诊的重要原因。CT对中晚期肾结核的诊断最有价值，螺旋CT尿路成像或MRU对并发输尿管结核的诊断有帮助。治疗上仍以肾切除为主，术中应尽可能切除患侧输尿管。     

肾结石并发肾结核的诊断(附6例报告)

目的：探讨肾结石并发肾结核的诊断方法。方法：回顾性分析６例此病患者临床资料。结果：临床诊断正确者１例,术后病理确诊者４例,１例因接受ＥＳＷＬ后尿液结核杆菌培养阳性而确立诊断,临床诊断准确率为１６．７％。结论：肾结石并发肾结核临床表现不典型,肾结核症状多被肾结石症状掩盖,故应注意临床资料中有提示意义的线索,对肾结石伴肾功能严重损害而患肾大小变化不显著尤应警惕并发肾结核。     

脊柱结核合并肾结核的临床特点及诊断治疗

目的：探讨脊柱结核合并肾结核的l临床特点及脊柱结核与肾结核二者外科治疗间的相互关系。方法：对我科1963～2000年间收治的30例脊柱结核合并肾结核患者的临床表现及诊断治疗进行回顾性分析。结果：30例脊柱结核合并肾结核者全部为18岁以上成年人。骨病灶相对集中于胸腰段及其上下椎体。临床症状以脊柱结核症状为主，而肾结核l临床症状多不典型。均行3～4联抗痨药物规范治疗，手术治疗23例，保守治疗7例。除术中死亡1例外，余29例随访1～10年，平均3年，病变治愈者28例，1例截瘫者大部分恢复，但仍需扶拐行走。结论：脊柱结核合并肾结核者肾结核的临床症状多不典型，易漏诊。脊柱结核伴尿常规异常者应警惕有合并肾结核之可能。脊柱结核合并肾结核的外科治疗应在规范化疗支持下进行，如骨、肾病变均需外科治疗，不论同期或分期手术，均以先处理肾脏病变为宜。     

肾结核326例临床分析

目的 探讨肾结核的早期诊断和治疗.方法 回顾分析326例肾结核患者的临床资料.结果 尿频、尿急、尿痛、腰痛和血尿是最常见的症状,分别为51.8%、37.2%、33.4%、41.0%和48.1%.IVP、B超、CT、膀胱黏膜活检和MRU诊断符合率分别为69.1%、46.6%、89.8%、44.4%和85.6%.96例抗结...     

Prevalence and manifestations of tuberculosis in renal transplant recipients: a single-center experience in Thailand

This retrospective review presented the prevalence and manifestations of tuberculosis among renal transplant recipients in our center between 1987 and mid 2007. The prevalence of tuberculosis was 5/151 (3.3%) recipients with a median age of 49 years (range = 38-55). The median time of diagnosis after transplantation was 23 months (range = 1-47). All five patients had pulmonary tuberculosis. None developed extrapulmonary infection. Presenting symptoms were fever (60%), productive cough (80%), weight loss (40%), and hemoptysis (20%). One patient had non-parathyroid-related hypercalcemia. Cyclosporine dosage needed to be increased in all patients. Two subjects who experienced side effects of hepatitis and/or jaundice from rifampicin were switched to second-line drugs. Infection with Mycobacterial tuberculosis is a not uncommon problem in renal transplant recipients especially in endemic areas. Tuberculosis must be excluded for immunosuppressed patients with clinical or radiological suspicion.     

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.     

Urinary tuberculosis: ten years' experience

In this study of 26 patients, clinical features diagnosed as urinary tuberculosis in our nephrology and urology clinics between 1993 and 2002 were investigated retrospectively. Fifteen patients (52%) were male, and mean age was 43.5 (18-71). Twenty percent of the patients were asymptomatic. Frequency-dysuria (46%), flank pain (33%), and macroscopic hematuria (12%) were presenting symptoms. Physical examination was not diagnostically helpful in most patients. Hematuria and/or pyuria were detected in 80% of the patients. Eleven patients had positive urine cultures of Mycobacterium tuberculosis (42%), and 7 patients had positive smears (25%). Definitive diagnosis of urinary tuberculosis was established microbiologically in 15 patients (58%) and histopathologically in 11 patients (42%). Tuberculin skin test was positive in 60% of the patients. Eight patients had an abnormal chest roentgenogram. Hydronephrosis (majority bilateral) in 11 patients (42%), contracted bladder in 9 patients (34.6%), and renal calcification in 6 patients (23%) were detected. Two patients also had genital tuberculosis (epididymoorchitis). Although only medical treatment was applied in 13 patients for 9 months, in the rest of the patients medical therapy plus surgical intervention was carried out. End-stage renal failure developed in one patient who died on hemodialysis. Renal functions had decreased moderately in two other patients. In conclusion, the diagnosis of urinary tuberculosis was able to be established after the obstructive complications and functional losses were developed in a fair number of cases. Surgical treatment was carried out in half the patients. Urinary tuberculosis should be taken into consideration because early diagnosis and treatment is very important for the presenting of irreversible sequelae.     

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.     

Tuberculosis in chronic kidney disease

BACKGROUND: The incidence of tuberculosis is high in chronic kidney disease (CKD) which needs a high index of suspicion, early diagnosis and management for gratifying outcome. MATERIALS: The clinical, laboratory profile, management and outcome of tuberculosis in 36 patients with chronic kidney disease between 2000 and 2005 constitute the material of this study. RESULTS: During this study period, over 900 chronic renal failure patients were evaluated in our unit and 36 of them were found to have tuberculosis, the incidence being 4%. In majority (69.4%), tuberculosis was observed in association with CKD Stage V. Age range was 25 - 77 years, male : female ratio was 33 : 3. Fever, malaise and weight loss were the commonest symptoms observed at presentation. Extrapulmonary tuberculosis (23 patients, 63.8%) predominated over pulmonary tuberculosis (10 patients, 36.1%). Tuberculin skin test was negative in 23 patients (63.8%). The diagnosis of tuberculosis was confirmed by tissue or specimen examination in 17 patients (47.2%) and in the rest it was empirical basing on clinical picture, pleural fluid analysis and radiological tests. All the patients were planned for a minimum period of 9-month antituberculous therapy (ATT). Of them, 17 patients (47.2%) were cured from tuberculosis and did not relapse, 9 patients (25%) died during treatment and 10 patients were lost for follow-up. Two patients were managed for anti-tuberculous therapy-related side effects: hepatotoxicity and psychosis. CONCLUSIONS: We observed a 4% incidence of tuberculosis in CKD. Extrapulmonary form of tuberculosis predominated over pulmonary form. Fever and malaise were important clues for suspicion of tuberculosis. Tuberculin skin test was negative in the majority. Diagnostic confirmation was possible in 47.2% of patients and in the rest it was based on clinical suspicion, pleural fluid analysis and radiological findings. Cure from tuberculosis was observed in 47.2% of patients with antituberculous therapy.