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.

Diagnosis and treatment of renal tuberculosis

Objective To discuss the diagnosis and treatment of renal tuberculosis.Methods A retrospective study was made on 96 cases.Results Frequency (51.8%), urgency (37.2%),odynuria (33.4%),lumbodynia (41.0%),and hematuria(48.1%)were the most common symptoms. The diagnostic accuracy of IVU, B-type ultrasonography, CT and biopsy of mucous membrane of urinary bladder were 69.1%,12.5 %,37.5% and 33.3% respectively. 96 cases were given medicine (INH+RFP+PZA or PIA for 6-8 months).38 cases(39.6%)have been cured, while symptoms of 43 cases (44.8%) have been improved. Operation was performed on 15 cases that were ineffective treated by chemical therapy. Conclusions Urine routine, IVP, cystoscopy+biopsy of mucous membrane of urinary bladder provide important information for the diagnosis of renal tuberculosis. INH, REP and EMB or PIA combination therapy yields satisfactory outcome for early cases.