强化抗结核治疗联合手术病灶切除对附睾结核诊治观察

目的:探析附睾结核诊治体会。方法:选取天津市海河医院2001年1月—2018年3月期间53例附睾结核患者为观察对象,均给予利福平、异烟肼或者乙胺丁醇强化抗结核治疗,2～4周后予以病灶切除术治疗,术中均给予附睾结核病灶清除,术后继续给予6～9个月常规抗结核治疗,总结分析患者治疗效果。结果:28例患者术后恢复良好,均治愈出院。随访8个月,24例患者无异常情况,3例患者分别在术后1个月、3个月、8个月时出现泌尿系结核感染,1例患者在术后8个月时出现对侧附睾结核。结论:对于附睾结核而言,强化抗结核治疗后及时给予手术治疗,可取得良好的预后。     

附睾结核100例报告

报告附睾结核100例,约30%的病人呈急性、恶急性炎症过程,72.6%合并前列腺结核,20%合并泌尿系结核。复习有关文献,着重讨论了附睾结核的临床诊断与鉴别诊断,认为生殖系结核以前列腺结核为中心,强调药物治疗的重要性,对单侧病变应尽量保留对侧功能。     

前列腺结核合并附睾结核一例报告

生殖结核临床上少见，多因症状不明显而漏诊或误诊。我科收治一例前列腺结核合并附睾结核患者，现报告如下：     

西藏地区44例男性附睾结核回顾性分析

目的:总结西藏地区附睾结核的发病情况及临床诊治过程,以提高附睾结核的诊治能力。方法:回顾性分析2014年10月～2019年10月西藏自治区人民医院收治44例附睾患者的临床资料。结果:附睾结核住院患者占同期住院人数的1.3%,均为藏族,发病年龄高峰为40～60岁。临床体征主要为阴囊疼痛伴触痛(65.9%)、无痛性阴囊肿大(34.1%)、串珠样输精管(22.7%)及阴囊窦道(15.9%)。17例(38.6%)患者有肺结核史;35例病理检查确诊结核病,12例睾丸受累;7例行脓液涂片抗酸杆菌镜检,阳性率57.1%;4例行脓液结核分枝杆菌和利福平耐药基因(GeneXpert MTB/RIF)检测,阳性率100%。单纯抗结核药物治疗9例,35例在抗结核药物治疗同时给予手术干预。所有患者出院后随访4周～2年,非手术患者药物治疗效果良好;手术患者无复发。阴囊结核无复发。结论:本地区附睾结核患者仍以中老年患者为主,大多数患者缺乏特异性临床表现而易早期误诊,延误治疗。使用抗结核药物联合手术是附睾结核的有效治疗方法。     

附睾结核的MRI 诊断价值

目的 分析附睾结核的MRI 表现,总结其MRI 的诊断要点.方法 对8 例经病理确诊为附睾结核的MRI 进行回顾性分析,重点分析其部位、形态、MRI 信号、强化方式及泌尿生殖系其他部位的情况.结果 8 例患者中2 例为局限于附睾附睾头的单发实性圆形小结节灶,6 例累及整个附睾弥漫性或多发形态不规则结节灶;4 例为实性病灶,2 例为囊实性病灶;8 例病灶实性部分T1WI 均呈等信号,T2WI 均呈低信号,囊性部分T1WI 呈低信号,T2WI 呈高信号.增强扫描8 例病灶中T2WI 呈低信号实性部分均明显强化.8 例患者中伴有泌尿系、睾丸、前列腺、精囊腺、肺结核分别为4 例、4 例、2 例、1 例及1 例.结论 附睾结核常伴发其他泌尿生殖系结核,典型的附睾结核多累及整个附睾,表现为在T2WI 呈低信号的实性病灶,且增强扫描明显强化,此MRI 特异性表现可以对附睾结核进行准确定位和早期诊断.     

附睾结核32例诊断和治疗

附睾结核是一种较常见的男性生殖系统疾病 ,我院 1997年 1月～ 2 0 0 2年 12月诊治附睾结核 32例 ,现报道如下。1　资料与方法本组 32例病人 ,年龄 15～ 70岁 ,平均 36 .8岁。病程 2个月～ 6年 ,平均 10 .9个月。左侧附睾结核16例 ,右侧 13例 ,双侧 3例。 2 8例附睾结核以阴囊肿物为主诉就诊 ,其中 17例为无痛性肿块 ,在无意间或检查其他疾病时发现 ,8例有阴囊坠痛或会阴部不适感 ,3例阴囊红肿疼痛剧烈 ;3例以阴囊窦道就诊 ;1例以肉眼血尿就诊。 12例伴有尿路刺激症状 ,7例伴有低热。本组 32例病人中 5例伴有肺结核或X线胸片肺部陈旧性结核…     

附睾结节116例分析

附睾结节是男性临床常见病之一[1] 。我院自 2 0 0 1年1月至 2 0 0 3年 1月间共收治 116例 ,现就其临床特点、诊治方法总结探讨如下。1　临床资料　116例附睾结节患者 ,年龄 19～ 79(平均 4 9.5 )岁 ,病程10d～ 10年 ,均行手术切除治疗 ,术后病理检查确诊。结节0 .8～ 6 .0cm。结节累及单侧 97例 (右侧 38例 ,左侧 5 9例 ) ,双侧 19例。其中位于头部 4 7例 ,尾部 6 1例 ,波及全段 8例。行附睾整段切除 4 7例 ,单纯结节切除 6 9例。病理分类 :非特异性炎性肉芽肿 2 8例 ,精子肉芽肿 19例 ,附睾结核 39例 ,精液囊肿 2 6例。良性肿瘤 4例 (纤维…     

附睾结节56例临床分析

附睾结节是男性常见病之一 ,本文分析 56例经手术病理证实附睾结节的临床特点 ,探讨其诊治方法。临床资料1992年 2月～ 1999年 11月经手术病理证实的附睾结节 56例 ;年龄 31～ 73岁 ,平均 4 7.6岁 ;双侧2例 ,右侧 2 5例 ,左侧 2 9例。大小为直径 ( 1～ 6)ｃｍ。病理类型包括 :囊肿 2 3例 ,精子肉芽肿 14例 ,结核 10例 ,腺瘤样瘤 4例 ,非特异性附睾炎 4例 ,腺纤维瘤 1例。 2例附睾囊肿血常规白细胞异常 ,1例左附睾结核伴血沉异常 ,1例左附睾结核出现尿检异常 ,余血常规、血沉及尿检均正常。讨　　论囊肿在附睾结节中占很大比重 ,其中又以精液…     

西藏地区睾丸和附睾疾病临床诊治分析

目的:通过对我院睾丸和附睾疾病的临床资料进行分析,探讨西藏地区睾丸和附睾疾病临床常见类型及治疗、防治措施。方法:回顾性分析2007～2009年我科收治的105例睾丸、附睾病例。结果:我区睾丸、附睾疾病发病率仍以结核、肿瘤为主,105例患者中,睾丸或附睾结核27例,睾丸肿瘤21例,睾丸鞘膜积液20例,隐睾12例,睾丸或附睾炎性病变13例,睾丸脓肿7例,睾丸外伤5例。同时发现患病人群99%的为藏区农牧民。结论:藏区农牧民对此类疾病认知、预防及治疗意识低下,故作为医生及相关机构仍需加强对睾丸和附睾疾患的宣传。     

Tuberculous epididymo-orchitis and prostatitis: a case report

The worldwide prevalence of tuberculosis (TB) is still high, remaining almost unchanged over the past century. The genitourinary tract belongs to one of the most common sites of extrapulmonary TB. Although rare, epididymal TB may be the only clinically evident location of infection. We present an unusual case of tuberculous epididymitis and prostatitis, demonstrating the need for insistent diagnostic procedures to confirm diagnosis. The treatment of choice is primarily medical, consisting of a combination of three or four anti-TB drugs, sometimes combined with surgery.     

Acute and Chronic Epididymitis

Epididymitis is a relatively common clinical condition presenting as acute or chronic forms. Acute epididymitis is the inflammation of epididymitis accompanied by pain and swelling, while chronic epididymitis may present only with pain. Etiological factors may be infectious or noninfectious, for example urinary obstruction, drug induced, or idiopathic. Bacterial ascent through the urogenital tract is the most common etiology in acute epididymitis, with Chlamydia trachomatis being isolated in all adult age groups. Diagnosis is generally based on patient history, symptoms, and clinical findings. Recent data indicate that sexually active patients with acute epididymitis should be screened for sexually-transmitted diseases, regardless of their age. Additional laboratory investigations and imaging may be required for differential diagnosis with other intrascrotal conditions, particularly with testicular torsion. Although no evidence-based recommendations can be given for the antimicrobial treatment of acute epididymitis, >85% of bacterial strains causing acute epididymitis are susceptible to fluoroquinoles and third-generation cephalosporins. Chronic epididymitis has not been investigated as thorough as acute epididymitis; however, the development and use of a symptom index is promising in terms of achieving a widely-accepted standardization of diagnosis and evaluation. A conservative approach may be beneficial; medical treatment employing antibiotics, anti-inflammatory agents, pain medication, and others are also being utilized without any evidence-based data. Spermatic cord block with short-term and long-term acting agents as well as surgical treatment including epididymectomy microdenervation of the spermatic cord are other treatment alternatives in patients with chronic epididymitis.Patient summaryIn this article, we provide an update on the definition, epidemiology, etiology, diagnostics, and therapy in terms of acute and chronic epididymitis.     

结核性附睾炎的超声诊断与鉴别诊断

目的 通过分析结核性和非结核性附睾炎的彩色多普勒声像图特征，提高对两种疾病声像图的认识和诊断准确率。方法 回顾分析经证实的90例非结核性附睾炎和15例结核性附睾炎的声像图特征。结果 附睾炎多位于附睾尾部或体尾部，以青壮年多见，两者的声像图相似，但又有区别，结核病灶旁阴囊壁层的结构破坏和睾丸受累是主要的鉴别点。结论 超声检查可作为结核性附睾炎症的重要辅助诊断和鉴别诊断方法。     

Epididymitis: revelations at the convergence of clinical and basic sciences

Acute epididymitis represents a common medical condition in the urological outpatient clinic. Mostly, epididymitis is caused by bacterial ascent through the urogenital tract, with pathogens originating either from sexually transmitted diseases or urinary tract infections. Although conservative antimicrobial therapy is possible in the majority of patients and is usually sufficient to eradicate the pathogen, studies have shown persistent oligozoospermia and azoospermia in up to 40% of these patients. Animal models of epididymitis are created to delineate the underlying reasons for this observation and the additional impairment of sperm function that is often associated with the disease. Accumulated data provide evidence of a differential expression of immune cells, immunoregulatory genes and pathogen-sensing molecules along the length of the epididymal duct. The evidence suggests that a tolerogenic environment exists in the caput epididymidis, but that inflammatory responses are most intense toward the cauda epididymidis. This is consistent with the need to provide protection for the neo-antigens of spermatozoa emerging from the testis, without compromising the ability to respond to ascending infections. However, severe inflammatory responses, particularly in the cauda, may lead to collateral damage to the structure and function of the epididymis. Convergence of the clinical observations with appropriate animal studies should lead to better understanding of the immunological environment throughout the epididymis, the parameters underlying susceptibility to epididymitis, and to therapeutic approaches that can mitigate epididymal damage and subsequent fertility problems.     

溶血孪生球菌感染引起附睾炎1例报道及文献回顾

目的报道1例溶血孪生球菌引起附睾炎病例,结合文献探讨其临床特点、感染途径、鉴别诊断及治疗。方法对手术切除的1例附睾组织行常规病理检查,抽取患者鞘膜内积液送检验科行细菌培养及药敏实验。结果病检提示附睾组织查见炎细胞,病变符合附睾炎,送检鞘膜组织伴淋巴细胞、浆细胞、嗜酸性粒细胞浸润,组织学符合鞘膜积液伴慢性炎症;细菌培养提示：溶血孪生球菌感染,对氨苄青霉素、头孢唑啉、红霉素、先锋必、环丙氟哌酸等敏感。结论溶血孪生球菌引起附睾炎十分罕见,其诊断依赖临床及检验,一旦发现此类感染,首先确定病原菌,迅速治疗,防止发生溶血孪生球菌引起心内膜炎。     

Tuberculous peritonitis in no risk patients: diagnostic approach

BACKGROUND: Incidence of tubercoulosis is increasing in Western countries particularly in immigrants from endemic areas and in patients with HIV or immunocompromised. The disease is unusual in patients without risk factors. In these conditions the diagnosis of tuberculous peritonitis is often delayed, resulting in high morbidity and mortality. METHODS: We describe a case of tuberculous peritonitis in a man suffering from ascites referred for presumed peritoneal carcinosis. The finding of no malignancies in the peritoneal fluid must rise the suspect of tuberculosis that, if misdiagnosed, is fatal. The patient was submitted to diagnostic videolaparoscopy and multiple biopsies were done. The definitive histological diagnosis was chronic granulomatous flogosis with giant cells, focally necrotizing, caused by peritoneal tubercolosis. RESULTS: The patient was submitted to chemotherapy with isoniazide, rifampicine, piazafoline, ethambutol and streptomycine which determined the resolution of the clinical picture. CONCLUSIONS: We believe the diagnostic procedure of choice is videolaparoscopy when tubercolous peritonitis is suspected. This technique allows to obtain selective biopsies of peritoneal nodules and to collect samples for specific cultural and cytohistological exams. The operation is safe, reliable with few complications and permits a prompt diagnosis necessary to cure the patient.     

Tuberculous dactylitis

Tuberculous dactylitis is a rare condition and a diagnostic challenge. Tissue biopsies can be negative for microscopy and culture. Polymerase chain reaction and DNA probes for mycobacterium tuberculosis can provide an earlier diagnosis. Surgery and antimicrobial therapy remain the mainstay of management.     

IFN-γ酶联免疫斑点法与结核菌素皮试在附睾结核检测中的应用比较

目的:将新兴的结核特异性IFN-γ酶联免疫斑点法(ELISPOT)应用于附睾结核检测,并比较其与传统的结核菌素皮试(PPD)在附睾结核及健康对照组中检测的差异,探讨ELISPOT在附睾结核诊断中的应用前景。方法:采用自主研制的ELISPOT试剂盒对13例附睾结核患者进行检测;采用PPD对11例附睾结核患者检测。同时采用2种方法对57例健康男性志愿者进行平行检测。结果:附睾结核患者,ELISPOT阳性率92.3%(12/13),PPD阳性率90.9%(10/11),2种方法差异无显著性(P>0.05)。健康志愿者中ELISPOT阳性率14.0%(8/57),PPD阳性率49.1%(28/57),两者差异有极显著性(P<0.01)。结论:附睾结核检测中ELISPOT在敏感性上与PPD一致,在区分附睾结核与健康人方面特异性优于PPD,在附睾结核诊断上有较好的应用前景。     

Tuberculous epididymitis： a case report and literature review

Tuberculous epididymitis is a rare urological disease difficult to diagnose. The conventional methods for diagnosis are often time-consuming and invasive. The combined use of scrotal magnetic resonance imaging （MRI） and urinary polymerase chain reaction （PCR）-based assay for mycobacterial DNA （the latter because of its high sensitivity and specificity to demonstrate mycobacterial DNA） is a valuable method for rapid diagnosis of tuberculous epididymitis. We report a 79-year-old man who was admitted with the chief complaints of bilateral scrotal swelling and pain. The combined use of scrotal MRI and urinary PCR allowed prompt diagnosis of tuberculous epididymitis and adequate antituberculous therapy. （Asian J Androl 2005 Sep; 7： 329-332）