中晚期肾结核43例诊治分析

目的：总结43例中晚期肾结核的诊治经验，以提高中晚期肾结核诊断准确性和治疗效果。方法回顾性分析2005年1月至2012年1月我科收治的43例中晚期肾结核患者的临床资料。结果膀胱刺激症状、肉眼血尿、腰痛为中晚期肾结核最常见临床症状，发生率分别为81．4％、65．1％、44．2％。实验室检查中，尿常规异常阳性率达90．7％，尿沉渣查抗酸杆菌有一定诊断价值。影像学检查中，CT诊断符合率最高（81．4％），同B超或泌尿系平片＋静脉肾盂造影（KUB＋IVU）比较，差异有统计学意义（P＜0．05），但同磁共振水成像（MRU）比较，差异无统计学意义（P＞0．05）。单纯抗痨治疗者5例，其中2例用药期间病情好转，但停药后加重，1例肾自截，2例无效。38例行手术治疗，其中肾切除术34例，肾及输尿管全长切除术4例；开放手术32例，腹腔镜手术6例。38例均治愈。结论泌尿系CT检查对中晚期肾结核具有较高诊断价值。中晚期肾结核大多需要手术治疗方能治愈，如对侧肾功能良好，建议切除患肾，不提倡施行肾部分切除术或脓肿穿刺引流术。

Diagnosis and treatment of 43 patients with advanced renal tuberculosis

Objective To summarize the diagnostic and therapeutic experience of advanced renal tuberculosis , so as to in-crease diagnostic accuracy and therapeutic efficacy of advanced renal tuberculosis .Methods Clinical data of 43 cases of medium or advanced renal tuberculosis admitted into our Department from January 2005 to January 2012 were analyzed retrospectively .Results Irritation signs of bladder , gross hematuria , and lumbodynia were the most commonly-seen symptoms of advanced renal tuberculosis , with incidence rates being 81.4%, 65.1%, and 44.2% respectively.In laboratory detection, acid-fast stains on urinary sediment seemed to have diagnostic value.Medical scanning indicated that the diagnostic accordance rate of CT was the highest （81.4%）, and statistical significance could be noted , when compared with ultrasonic examination or KUB ＋IVU（P〈0.05）.However, no statistical significance could be seen, when it was compared with MRU（P〉0.05）.Five cases underwent purely anti-tuberculosis treatment and 2 of the cases improved during medication , but were deteriorated after drug withdrawal .There was one case of autonephrectomy , and 2 cases failed to respond to anti-tuberculosis treatment .Thirty-eight patients underwent surgical treatment , of whom 34 patients underwent nephrectomy , 4 patients underwent nephroureterectomy with bladder cuff .There were 32 cases of open surgery , of which 6 cases under-went laparoscopic surgery .All the 38 cases were cured .Conclusion Urinary tract CT examination has a high diagnostic value for medi-um or advanced renal tuberculosis .Patients with medium or advanced renal tuberculosis mostly required surgical therapy for final cure of the disease.If the contralateral renal function was good , the affected kidney could be removed .And it was not advisable to perform par-tial nephrectomy or percutaneous catheter drainage of tuberculous abscess .