不典型泌尿系结核的诊治(附23例报告)

目的：探讨肾结核的诊断与治疗方法。方法：回顾性分析23例肾结核患者的临床资料，将不典型泌尿系结核分为七类。结果：除膀胱刺激征、血尿等最常见的症状外，泌尿系结核的临床症状越来越不典型。除肾功能尚好的6例采用联合服药治疗，2例随访治愈外，余17例行患肾及输尿管切除术，术后病理检查诊断为肾结核。6例获得随访，2例并发结核性小膀胱，2例并发输尿管残端综合征，2例痊愈。结论：静脉肾盂造影（IVP）是肾结核首选的有诊断意义的检查方法，对不典型肾结核的诊断需要在提高认识的同时重视病史，综合分析尿细菌学及IVP检查，必要时联合逆行肾盂造影（RP）、CT检查才能确诊。个别患者只有在手术时才能确诊。强调晚期肾结核行半尿路全切除术十分重要；肾功能尚好的早期肾结核患者行三联化疗是有效的。

The diagnosis and treatment of non-typical renal tuberculosis (Report of 23 cases)

Objective:To Study the diagnosis and treatment of the renal tuberculosis(TB).Methods:By the analysis of 23 renal tuberculosis, the non-typical urine tuberculosis is divided into 7 type.Results:Except for the bladder stimulates symptom and blood urine, the clinical symptom of the urine tuberculosis is less and less non-typical. Except that the 6 patients of the kidney function is good were treated with a associated medicine,2 example followed , all were cured.17 patients were operated by urethra resection, They were diagnosed as renal TB after operation by pathology examines,6 patients were followed up;2 cases were complicated with the small bladder in tuberculosis,2 examples developed ureteral stump syndrome,2 cases cured.Conclusions:The IVP examine is first choice and diagnostic meaning method for the renal TB, For the diagnosis and treatment of non-typical renal TB we should enhance knowing, value the disease history , synthesize and analysis urine mycology and IVP examine. Retrogra:De pyelography and CT scan is played when necessary for confirmation, the few cases could only confirmed through surgical operation. we should emphasize the importance of non-functioning kidney is resected the involved ureter should be resected completely during later period of renal tuberculosis. three sorts of medicine chemotherapy is valid for the patients during earlier period of kidney whose renal function are good.