肾结核155例诊治分析

目的 探讨肾结核的临床表现、诊断和治疗,以提高早期诊治水平. 方法 回顾性分析我院2003年7月—2014年4月收治的155例肾结核患者的临床资料.结果 肾结核高发年龄段是40~60岁(47.1%).将患者分为2组,具有3种或以上临床常见症状者为典型肾结核组(典型组),有患者94例;其余为不典型肾结核组(不典型组),有患者61例.临床最常见的症状依次为尿急(62.6%)、尿频(60.0%)、腰痛(54.3%)、尿痛(51.6%)和血尿(44.5%),腰痛是不典型肾结核组最常见的症状(49.2%).132例患者行尿沉渣找抗酸杆菌检查,阳性率为31.8%.超声检查结果异常率为84.5%,诊断符合率为38.1%.CT检查结果异常率为95.1%,诊断符合率为79.9%. 123例患者行手术治疗,其余32例患者接受抗结核药物治疗. 结论 肾结核的诊断主要依靠临床症状、 实验室检查和影像学检查,CT对明确诊断有重要意义. 肾结核早期诊断困难且需要综合分析判断. 手术是中晚期肾结核的重要治疗手段.

Diagnosis and treatment of 155 patients with renal tuberculosis

Objective To investigate the clinical manifestations, diagnosis and treatment of renal tuberculosis, so as to improve the early diagnosis and treatment of renal tuberculosis. Methods A total of 155 patients with renal tuberculosis treated in our hospital from Jul. 2003 to Apr. 2014 were analyzed retrospectively. Results Renal tuberculosis occurred mostly in patients aged 40-60 years old (47.1%). The patients with 3 or more than 3 common clinical symptoms were regarded as a typical group (94 patients), and the others as an atypical group (61 patients). The most common clinical symptoms included urinary urgency (62.6%), urinary frequency (60.0%), flank pain (54.3%), odynuria (51.6%) and hematuria (44.5%). Flank pain (49.2%) was the most common symptom in the atypical group. Of all the patients, 132 were examined by acid-fast stain, with a positive rate of 31.8%; 131 patients (84.5%), who had an ultra-sonography, had an abnormal findings and 59 patients (38.1%) of them were definitively diagnosed;137 patients (95.1%) of the 144 pa-tients, who had a CT, had an abnormal findings and 115 patients (79.9%) of them were definitively diagnosed. Surgical treatment was given to 123 patients, while 32 patients only received antituberculosis drugs. Conclusions The diagnosis of renal tuberculosis mainly relys on clinical manifestations, laboratory findings and imaging findings. CT plays an important role in making definite diagnosis. Early diagnosis of renal tuberculosis is difficult and needs comprehensive analysis. The surgical treatment is needed for advanced renal tuberculosis.