肾结石并发肾结核的诊治

目的:探讨肾结石并发肾结核的诊断、治疗方法.方法:回顾性分析10例此病患者临床资料.结果:男性8例,女性2例,平均40.8岁.10例均有患侧腰背疼痛及叩击痛,经尿常规、尿查抗酸杆菌、B超、CT等检查,临床诊断肾结石伴患肾无功能7例,肾结石1例,肾结石伴肾结核2例,其中2例尿液结核杆菌检测阳性而确诊,临床诊断准确率为20%(2/10).7例接受患肾切除,1例为肾盂切开取石,2例接受体外震波碎石术ESWL,术后病理确诊输尿管、肾结石并发肾结核8例,确诊后均予抗结核药治疗,随访3～24月均未见复发.结论:肾结石并发肾结核临床表现不典型,肾结核症状多被肾结石症状掩盖,患者大多肾功能损害严重而患肾大小变化不著,尿常规及查抗酸杆菌和IVU、CT等影像学检查对确立诊断具有重要价值,抗结核同时治疗结石是其治疗的核心,提高对肾结核的认识有助于提高治疗效果.

DIAGNOSIS AND TREATMENT OF RENAL CALCULI ASSOCIATED WITH RENAL TUBERCULOSIS

Objective:To improve the diagnosis and treatment of renal calculi associated with renal tuberculosis.Methods:10 cases(8 men and 2 women) were analyzed retrospectively.Results:Patients'average age was 40.8 years.The clinical manifestations,laboratory examinations and imaging characteristics were presented.7 cases were performed nephrectomy,1 case underwent pyelolithotomy and 2 cases were treated ESWL.Anti-tuberculosis drugs were given after establishing the diagnosis.The clinical diagnosis accuracy was 20%(2/10) .During 3 to 24 months follow-up there was no recurrence found.Conclusions:Flank dull ache,irritative symptoms and gross hematuria were the most common symptoms encountered in these patients.The diagnosis of renal tuberculosis was easily to be neglected in such patients.The diagnosis of renal calculi associated with renal tuberculosis is primarily based on acid-fast stains of urinary sediment,TB-PCR and imaging testings,and pay attention to the no enlargement and nonfunctional kidney with calculi.The key to early establishing diagnosis of renal calculi associated with renal tuberculosis is careful analysing of clinical data.