肾结核39例临床分析

目的探讨肾结核的诊断和治疗方法。方法对39例肾结核患者进行回顾性分析。12例行药物治疗,27例于抗结核治疗2周后行一侧患肾切除术。结果尿路刺激症状和血尿为常见症状。尿沉渣检查抗酸杆菌阳性9例,同期尿结核杆菌-PCR(Tb-PCR)检查35例,阳性20例。静脉尿路造影(IVU)检查39例,异常改变者32例;B超确诊14例;CT确诊33例。误诊主要为结石或炎症。12例药物治疗均痊愈;27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Tb-PCR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。

CLINICAL ANALYSIS OF RENAL TUBERCULOSIS: A REPORT OF 39 CASES

Objective To study the diagnosis and treatment of renal tuberculosis(TB).Methods A retrospective study was made on 39 cases.Results Irritation and hematuria were the most common symptoms.The positive results of acid-fast stains were 9 cases,at the same time,35cases were examined by urinary TB-PCR,and 20 had the positive results.32 of 39 cases had the positive changes in the examination of urography.The diagnosis accuracy of B-type ultrasonography and CT were14 cases and 33 cases,respectively.12 cases were treated with medicine and all of them were cured;27 cases were treated with operation and all were proved by pathologic diagnosis.Conclusion Acid-fast stains remains an important pathogen-detecting tool;Urinary TB-PCR is the major diagnosis instrument before operation;IVU and B-type ultrasonography are the first choice for imaging diagnosis,and CT scan is helpful sometimes.When surgical intervention is needed,nephrectomy and patial ureterectomy is the first choice.