肾结核诊断与治疗

目的探讨肾结核诊断与治疗。方法对46例肾结核患者的诊断及治疗进行回顾性研究。结果尿查抗酸杆茵、尿聚合酶链反应结核茵和血清抗结核特异性抗体的准确率分别为15．7％、50％和44％。B超、静脉肾孟造影、逆行性肾孟造影和CT准确率分别为24．2％、57．9％、66．7％和80．6％。单纯抗结核药物治愈11例。患肾切除32例，患肾造瘘、肾孟输尿管离断成型1例，输尿管膀胱再植入1例。扩大膀胱术1例。结论B超、静脉肾孟造影对肾结核的诊断缺乏特异性。聚合酶链反应结核茵、CT在肾结核诊断中起着越来越重要的作用。肾结核治疗仍以肾切除术为主要方法，同时应尽可能切除患侧输尿管。

Diagnosis and treatment of renal tuberculosis

[Objective] To investigate the diagnosis and treatment of renal tuberculosis(RT). [Methods] The documents of 46 cases of patients withRT were retrospectively reviewe. [Results] The positive rate of urine acid-fast stains, polymerase chain reaction of tuberculosis(PCR-TB-DNA), dserumPPD-IgG were, 15.7%, 50%, 44% respectively. The positive rate of ultrasonography, intravenousurography(IVU), retrogradepyelography, computerized tomography(CT) were 24.2%, 57.4%, 66.7%, 80.6%, respectively. Antituberculosis chemotherapy was used in 11 cases of patients. Nephrectomy was was performed in 32 cases, nephrostomy in combination with dismembered pyeloplasty was performed in 1 case, Ureteroneocystostomy was performed in 1 case. Augmentation cystoplasty was performed in only 1 case. [Conclusions] Ultrasonography, IVU can not be regarded as a specific examination in diagnosing RT, PCR-TB-DNA and CT play more and more importment role in the diagnosis of RT. Nephrectomy is the main way in the treatment of RT, remove as much as possible of the ureter is required.