输尿管镜活检术在不典型泌尿系结核诊断中的应用价值

目的探讨输尿管镜活检术在不典型泌尿系结核诊断中的临床应用价值。方法回顾分析11例泌尿系结核患者的临床资料及其应用输尿管镜活检术诊断的结果,并与同期进行的尿沉渣抗酸杆菌检测和泌尿系影像学检查结果进行比较。结果所有的患者均加行输尿管镜活检术,结果11例中有8例活检病理诊断证实为输尿管结核或结核性膀胱炎,诊断阳性率为72.72%,高于同期的尿沉渣抗酸杆菌检查诊断的4例(36.37%阳性率)和泌尿系影像学检查诊断的6例(54.54%阳性率);11例中还有3例输尿管镜活检术诊断为输尿管黏膜慢性炎症,考虑患肾已无功能,最后均予患肾及部分输尿管切除,术后病理证实为泌尿系结核。所有输尿管镜活检术后的病例均无严重并发症发生。结论输尿管镜活检不失为一种有效、较特异和安全的诊断泌尿系结核的方法之一。     

睾丸结核11例临床分析

目的：分析睾丸结核误诊误治的相关因素,探讨临床睾丸结核诊断及治疗方法。方法：回顾性分析2008～2011年收治11例睾丸结核患者的临床资料。结果：睾丸结核患者病史3～18个月。11例睾丸结核中合并附睾结核10例,合并肺结核6例。5例曾被误诊为附睾睾丸炎。误诊主要原因是早期临床表现不典型,缺乏影像学检查。11例中,7例通过术后病理检查结果确诊,4例经睾丸穿刺活检确诊。误诊时间平均4个月。3例经6个月抗结核治疗后痊愈,8例经抗结核及手术治疗后痊愈,随访6个月未见复发。结论：睾丸结核临床少见,漏误诊率较高。B超、CT、MRI和睾丸穿刺细胞学检查有助于睾丸结核诊断。对于局部于酪样坏死严重,病变较大且有脓肿形成或抗结核治疗效果不明显的患者可以考虑手术治疗。     

32例重度增生腺性膀胱炎临床诊断治疗

目的 探讨重度增生腺性膀胱炎的诊断及治疗措施.方法 对2009年12月～2013年12月新疆维吾尔自治区人民医院泌尿外科经影像学考虑为膀胱内实性占位、病理学检查确诊的32例重度增生腺性膀胱炎患者的病历资料进行回顾性的临床分析.患者均行经尿道等离子电切术,术后给予药物灌注治疗.结果 32例患者随访3～ 48个月,25例(78％)症状得以不同程度的恢复,行膀胱镜检查正常.6例(24％)出现复发,行再次手术更换膀胱灌注药物后,未出现复发.1例患者术后1年合并膀胱结石,行经尿道碎石取石并病灶黏膜电灼术.所有随访患者均未发现恶变.结论 彩色多普勒超声检查联合CT增强可提高对腺性膀胱炎定性诊断的准确性.经尿道等离子电切术联合术后膀胱灌注治疗重度增生腺性膀胱炎效果明显,安全有效,术后复发率低.     

食管结核的诊断和外科治疗

目的 探讨食管结核的临床病理特征、诊断及外科治疗方法,减少误诊发生.方法 回顾性分析11例患者的相关临床资料.结果 术前诊断为食管结核2例;误诊9例,分别诊断为食管癌7例、食管平滑肌瘤2例.药物治疗2例,手术治疗9例,手术方式包括病灶段食管切除+胃食管吻合术5例、淋巴结切除术2例、胃造瘘术1例,1例术中冰冻切片检查证实结核而未切除食管,术后无严重并发症发生.11例患者均经病理证实为食管结核,全部治愈,随访1～27年,症状均消失,结核无复发.结论 食管结核属罕见良性疾病,临床无特异征象,与食管癌和食管良性肿瘤鉴别困难.术前明确诊断后采用药物保守治疗有效,如出现并发症则需外科干预,术后需抗结核治疗12～18个月,预后较好.     

甲状腺结核的诊治--附1例报告并国内87例临床分析

目的:探讨甲状腺结核的早期诊断和治疗.方法:报告1例误诊长达7月的甲状腺结核,回顾分析国内经针刺细胞学或术后病理确诊为甲状腺结核的87例患者的临床资料.结果:15例行针刺细胞学检查,余均经手术病理确诊.术前大多数误诊为甲状腺癌、甲状腺腺瘤,少数误诊为地方性甲状腺肿、结节性甲状腺肿、甲亢等.结论:甲状腺肿块伴发热及结核史者应考虑甲状腺结核的可能,细针穿刺活检是协助诊断简便有效的方法.病灶清除及抗结核抗药物局部灌洗、正规抗痨治疗预后好.     

输尿管镜在早期泌尿系结核诊治中的应用

目的:探讨输尿管镜在早期泌尿系结核诊断和治疗的应用价值。方法:回顾性分析21例应用输尿管镜诊断和治疗早期泌尿系结核患者的临床资料。21例输尿管镜表现分别为输尿管狭窄14例、输尿管开口炎性水肿4例、输尿管下段息肉3例。18例通过输尿管镜收集肾盂尿作结核杆菌聚合酶链反应(MTb-PCR)、沉渣找抗酸杆菌(AFB)检查和结核杆菌培养诊断为泌尿系结核,其中16例(88.9%)尿MTb-PCR呈阳性,11例(61.1%)尿沉渣找AFB阳性,7例(38.9%)结核杆菌培养阳性。3例输尿管下段息肉,用输尿管镜摘除息肉作病理检查,2例病理诊断为输尿管结核,1例误诊为输尿管炎性息肉。11例输尿管下段狭窄予行输尿管镜狭窄内切开术,其余10例予行输尿管镜扩张置管术。除误诊为输尿管炎性息肉的1例患者外,20例术后均予抗结核治疗至少6个月。结果:21例平均随访18个月,12例(57.1%)一次手术治愈;8例出现狭窄复发,5例需再次行输尿管镜狭窄内切开术治愈,3例因狭窄多次复发致无功能肾行患肾切除术;误诊为输尿管炎性息肉1例,术后12个月复查发现患侧结核性脓肾及膀胱挛缩,予行患肾切除+乙状结肠膀胱扩大术。结论:早期泌尿系结核可表现为输尿管狭窄、输尿管开口炎性水肿或输尿管下段息肉。输尿管镜技术有助于早期诊断和治疗泌尿系结核。     

输尿管镜在不典型泌尿系结核诊断中的应用(附6例报告)

目的探讨输尿管镜检查在不典型泌尿系结核诊断中的应用价值。方法回顾性分析6例应用输尿管镜检查诊断的不典型泌尿系结核患者的临床资料。结果6例均在输尿管镜下取活组织检查,5例证实为输尿管结核,1例诊断为输尿管黏膜慢性炎症,行肾及部分输尿管切除后病理证实为肾结核,无1例产生并发症。结论对于临床表现不典型的泌尿系结核,尤其是以梗阻症状为主要表现者,输尿管镜检查是安全有效的诊断方法。     

膀胱黏膜活检诊断泌尿系结核的价值(附46例报告)

目的:探讨膀胱黏膜活检诊断泌尿系结核的临床价值。方法:回顾性分析46例泌尿系结核患者的临床资料与膀胱镜活检的结果,并与同期进行的尿沉渣抗酸杆菌检查和泌尿系影像学检查进行比较。结果: 46例患者中有31例活检病理诊断为结核性膀胱炎,诊断阳性率为67. 4%,高于同期进行的尿沉渣抗酸杆菌检查的19. 5% (9 /46)和泌尿系影像学检查的41. 3% (19 /46) (P均<0. 05)。活检后无严重的并发症发生。结论:膀胱黏膜活检是诊断泌尿系结核的一项敏感、特异和有效的方法。     

胰腺结核误诊为胰腺肿瘤八例临床分析

目的 探讨胰腺结核误诊为胰腺肿瘤的原因及预防方法.方法 通过对8例胰腺结核误诊为胰腺肿瘤患者的临床特点分析,探讨误诊原因及提出正确的诊治方法.结果 8例误诊病例临床表现为:发热5例,腹痛4例,腹部包块3例,黄疸2例,盗汗3例,体重下降5例.影像学提示胰腺肿瘤表现,所有患者术前均诊断为胰腺肿瘤,均行剖腹探查术,术中5例快速切片病理证实为胰腺结核,终止手术.另3例行胰十二指肠切除,术后病理证实为胰腺结核.全部病例术后均接受抗结核治疗.随访2年,无复发.结论 发热、腹痛、影像学检查胰腺有局限性性病灶的患者,应考虑胰腺结核的诊断.应进一步行B型超声或CT引导下细针穿刺检查,从而及时作出正确诊断,减少误诊误治.     

误诊为胰腺肿瘤行手术切除的胰腺结核6例临床分析

目的：探讨胰腺结核的诊断和治疗方法。方法：回顾分析近3年误诊为胰腺癌的6例胰腺结核病例。结果：6例病人中有结核病史2例。临床表现为腹痛1例,腹胀5例,体重减轻1例,便血1例。6例均经剖腹探查．病理学证实;其中4例获病灶切除。全部病例均经术后抗结核治疗。6例中出现肠瘘1例,顽固性腹泻2例,区域性门静脉高压、食管下段静脉曲张各1例。结论：胰腺结核易被误诊为胰腺肿瘤而手术,故对影像学检查证实胰腺有局限性、囊性病变伴病灶周围及后腹膜淋巴结肿大,且肿瘤指标正常者,应考虑胰腺结核可能。切除胰腺结核可能发生的并发症较为严重,手术治疗应慎重考虑。     

Nonobstructive detrusor myopathy in a group of patients with chronic abacterial cystitis

Chronic abacterial cystitis is clinically and pathoanatomically an ill-defined condition, presenting with a variety of urologic symptoms and often nonspecific histology. A retrospective histologic analysis of bladder biopsies from 101 patients with chronic abacterial cystitis revealed degenerative changes in the detrusor muscle cells (detrusor myopathy) in 25 of them. The changes were often very severe, and even fatty replacement of muscle tissue was seen. Retrospective analysis of the symptoms, urodynamics and cystoscopic findings in these patients showed that none had haematuria, but five (all women) had had urinary retention requiring catheterization. Significant residual urine was found in nine patients, and the cystometrograms showed a shift to the right. No patient had infravesical obstruction. At cystoscopy less than half of the patients had petechial bleeding after bladder distension. The aetiology and pathogenesis of the degenerative changes are unknown, despite theoretic speculation. The authors conclude that careful histologic examination can identify different clinical types of chronic abacterial cystitis. Such studies may assist future research into the nature of the problem and also the search for more rational therapy.     

The tomitsid treatment of chronic cystitis in children

The clinical efficiency of tomicid used in the treatment of childhood cystitis was examined by employing clinical, endoscopic, microbiological, and immunological findings. A total of 140 children were examined. These include 78 with chronic obstructive pyelonephritis without cystitis and 62 with chronic cystitis. The urinary bladder was instilled with reference tomicid solution in 18 children with chronic cystitis during 10-12 days. Tomicid was found to produce bactericidal and anti-inflammatory effects. The immunomodulating effect was shown mainly in young children (aged 1-6 years). The lack of toxic and adverse effects of the drug allows one to recommend for use in pediatric urologic practice.     

上尿路移行细胞癌12例误诊分析

目的探讨上尿路移行细胞癌的误诊原因。方法回顾性分析12例上尿路移行细胞癌患者在诊治过程中的误诊情况。误诊为肾炎4例,上尿路结石3例,泌尿系感染3例,肾结核1例,前列腺增生1例。结果 12例患者均经手术治疗,术后病理证实肾盂移行细胞癌9例,输尿管移行细胞癌3例,伴膀胱移行细胞癌2例。通过B超、静脉尿路造影（IVU）、逆行肾盂造影、CT、输尿管镜及膀胱镜等检查均提示发现肿瘤病灶。8例患者随访6个月~15年,3例死于肿瘤进展,2例术后出现膀胱移行细胞癌。结论对长期血尿病史患者需进一步病因检查,B超、IVU、CT等影像学检查具有重要的诊断价值,同时应提高对检查结果的正确分析和判读能力。     

Enterocystoplasty and renal transplantation

PURPOSE: We report on our experience with renal transplantation in patients with severe chronic bladder contracture who underwent prior intestinal bladder augmentation, and assess the safety of the procedure. MATERIALS AND METHODS: A total of 7 patients with severe alterations to the lower urinary tract and renal insufficiency underwent enterocystoplasty before renal transplantation. The etiologies of the bladder dysfunction were bladder contraction secondary to urinary tuberculosis in 4 cases, neurogenic bladder secondary to myelomeningocele in 1, chronic cystitis secondary to intravesical instillation of glutaraldehyde in 1 and hyperreflexic, contracted bladder in 1. Mean patient age was 38.4 years (range 19 to 57). The intestinal segment used was ileal conduit in 6 cases and an ileocaecal segment in 1. All 7 patients have received renal transplant from cadaveric donors. RESULTS: Graft survival rate was 100% and graft function was good after a mean followup of 48 months (range 8 to 97). Of the patients 6 are continent and void spontaneously and 1 requires intermittent self-catheterization. CONCLUSIONS: In our experience bladder augmentation is an acceptable method, although not exempt from complications, for patients with alterations to the lower urinary tract and who are candidates for renal transplantation.     

Early Identification of Interstitial Cystitis May Avoid Unnecessary Hysterectomy

Background:

Interstitial cystitis is a clinical syndrome characterized by symptoms of pelvic pain, urinary urgency and frequency, and nocturia. It can be difficult to accurately identify interstitial cystitis because the symptoms overlap many other common gynecologic and urologic conditions. Patients with undiagnosed interstitial cystitis may undergo unnecessary procedures, including hysterectomy.

Methods:

A PubMed literature search for articles dating back to 1990 was conducted on the topics of interstitial cystitis and hysterectomy. Further references were identified by cross-referencing the bibliographies in articles of interest.

Results:

The literature review found that hysterectomy is performed more often in patients with undiagnosed interstitial cystitis than in patients with a confirmed diagnosis. Interstitial cystitis often coexists with conditions like endometriosis, for which hysterectomy is indicated. Many patients subsequently diagnosed with interstitial cystitis continue to experience persistent pelvic pain despite having had a hysterectomy for chronic pelvic pain. Careful history and physical examination can identify the majority of interstitial cystitis cases.

Conclusion:

Interstitial cystitis should be considered prior to hysterectomy in women who present with pelvic pain or who experience pelvic pain after a hysterectomy. If interstitial cystitis is diagnosed, appropriate therapy may eliminate the need for hysterectomy.     

Gynecological urologic disease: a summary of clinical experience during the last 4 years at Wakayama Red Cross Hospital

From April 1979 to March 1983, sixty seven patients with gynecological urologic disease were experienced at our department. Forty one of them were inpatients, i.e., 15.3% of the total number of female in patients admitted during the same period. Thirty three urologic operations were performed on them which corresponded to 16.1% of the total operations on female patients. Ten of these patients had ureteral obstruction following gynecological operation, 8 had ureteral fistula, 7 had vesicovaginal fistula, 11 had tumor invasion to urinary tract, 14 had radiation cystitis, 16 had neurogenic bladder dysfunction, and 1 had other complication. The treatment of these patients and the results are summarized and discussed.     

改良后路病灶清除打压植骨内固定治疗胸腰椎结核

目的:探讨改良后路病灶清除打压植骨内固定治疗胸腰椎结核的可行性及疗效。方法:2005年1月～2010年3月收治的胸腰椎结核患者中,对17例连续2个节段病变的患者采用改良后路病灶清除、打压植骨、短节段内固定术。T12～L1 4例,L1～L2 7例,L2～L3 6例。影像学检查均有椎旁小脓肿;术前后凸Cobb角22°～50°,平均31.2°;均伴神经功能障碍,ASIA分级C级9例,D级8例。术前、术后常规抗结核药物治疗和营养支持治疗。结果:患者均顺利完成手术,术中无脊髓、大血管及重要脏器损伤。手术时间155.4±21.6min,出血量511.8±98.2ml,输血量164.7±157.9ml,住院时间14.7±1.0d。术后2例患者出现神经根性刺激症状,1～2周后症状缓解;1例术后半年原切口皮下寒性脓肿形成并溃破,经换药治疗后痊愈。随访13～47个月,平均30个月,术后和末次随访时的Cobb角分别为13.0°±5.6°和14.8°±5.8°,矫正率和丢失率分别为58.3%、5.8%。术后4～7个月植骨均愈合,随访期间内固定无松动、断裂及脱落,均无结核复发。末次随访时3例术前ASIA C级患者恢复至D级,余均恢复至E级。结论:对连续2节段胸腰椎(T12～L3)结核患者在有效抗结核药物治疗的前提下采用改良后路病灶清除打压植骨内固定术安全、有效。     

肺泡蛋白沉积症患者及合并严重感染的病例临床分析

目的通过分析肺泡蛋白沉积症（PAP）及合并严重感染的PAP患者误诊、误治情况及其原因,以提高PAP的临床诊治水平。方法回顾性分析确诊的PAP患者84例及其中6例合并严重感染的PAP患者的临床表现,入院前的误诊、误治情况及后果。结果84例PAP患者中66．7％（56／84）存在误诊,其中32．1％（27/84）误诊为特发性间质性肺炎（IIP）,14．3％（12／84）误诊为肺结核。88．1％（74/84）患者曾接受抗感染治疗,33．3％（28／84）患者曾接受糖皮质激素治疗,19．0％（16／84）曾接受抗痨治疗。患者在院外行支气管镜检查率仅为53．6％（45／84）。84例患者中86．9％（73／84）通过支气管镜、支气管肺泡灌洗（BAL）及经支气管镜肺活检（TBLB）确诊。确诊PAP时有6例患者合并严重感染,全部曾误诊为IIP并接受糖皮质激素治疗,2例死亡。结论PAP患者误诊、误治仍很普遍,误用糖皮质激素治疗导致部分患者出现严重感染。应重视PAP的影像学特征,积极行支气管镜、BAL、TBLB检查,避免误诊。诊断不明确时务必慎用糖皮质激素。     

Canal wall down in tuberculosis matoiditis: 4 case series

BackgroundTuberculosis of the ear and temporal bone is an extremely rare case.MethodsThis case series was reported using the 2020 PROCESS Guideline. The design of this study used a retrospective study during the 2017–2019 period.ResultsFour cases of tuberculosis mastoiditis with age range between 16 and 66 years from 2016 to 2019. All patients presented with chronic ear discharge from chronic ear with signs of mastoiditis with intra- and extra-temporal complications. All patients underwent radical mastoidectomy, and histopathologic examination showed tuberculosis. All patients received anti-tuberculosis drug first and second category.ConclusionClinical features of tuberculosis mastoiditis may vary. The diagnosis of tuberculosis mastoiditis can be examined through histopathologic examination and geneXpert tuberculosis. Surgical treatment and anti-tuberculosis administration are the primary choices in the management of tuberculosis mastoiditis.