肾结核临床诊治的新特点

目的：探讨肾结核诊治的新特点,提高肾结核尤其是不典型肾结核的临床治疗水平。方法：对经病原学或病理学证实的87例肾结核患者的诊断、鉴别诊断及治疗进行回顾性研究。结果;综合运用尿常规、肾脏功能测定、红细胞沉降率、尿找抗酸杆菌、尿荧光TB检测、尿PCR-TB;器械检查包括膀胱镜、B超、静脉肾盂造影（IVU）、CT等;主要鉴别肾脓肿、肾盂输尿管连接部狭窄、肾肿瘤、输尿管结石等疾病,获得确诊。保守治疗;单纯抗结核药物治疗16例,抗痨及血液透析1例;手术治疗;患肾切除54例（62.5％）,（孤肾）肾造瘘3例,肠道代膀胱术4例（4.6％）。结论：近年来肾结核呈现非典型化,应强调对非典型肾结核的诊断和鉴别诊断;静脉肾盂造影（IVU）对肾结核的诊断缺乏特异性,应重视CT在肾结核早期诊断中的作用。治疗上仍以肾切除为主。

Characteristics on diagnosis and treatment of renal tuberculosis

Objective To study the new characteristics on diagnosis and treatment of renal tuberculosis (RT). Methods Eighty-seven patients with renal tuberculosis were retrospectively reviewed; their diagnosis was established by standard microbiological and histological techniques. Results Atypical RT was diagnosed by various examinations, including urinary analysis, polymerase chain reaction of tuberculosis(PCR-TB), ultrasonography, intravenous urography(IVU), and computerized tomography(CT). Treatment consisted of antituberculous chemotherapy in all patients, in combination with nephrectomy (62.5%) or enterocystoplasty (4.6%). Conclusions The differential diagnosis of RT should be emphasized, especially for atypical RT , provided a much more specific diagnosis in clinical suspicion of RT. IVU can not be regarded as a specific examination for RT. Computerised tomography(CT) can be used for early diagnosis of RT.Surgery for RT is still ablative.