非典型肾结核45例诊治分析

目的：提高对非典型肾结核临床特点的认知及诊治水平。方法：回顾性分析1979年1月～2009年12月收治的45例非典型肾结核患者的临床资料：男24例，女21例，年龄19～61岁，平均38岁，其中20～50岁者38例，占84．4％。临床表现为尿频31例（68．9％），肉眼或镜下血尿9例（20．0％），尿常规不正常36例（80．0%）。15例（62．5％）男性患者曾诊为慢性前列腺炎，治疗1～3年无效，后诊为肾结核；7例伴有附睾结核，其中3例已在外院行附睾切除术。治疗前行尿路造影、CT和B超检查。9例采用异烟肼加利福平加乙胺丁醇药物治疗，疗程9～12个月；36例于抗结核治疗2、3周后行患肾切除术，4例加行附睾切除。结果：尿路造影、CT和B超诊断准确性分别为21．2％、100％和88．9％。36例手术治疗者全部治愈，9例药物治疗者中，5例在6～24个月复查时，患肾损坏严重，遂行肾切除。结论：非典型肾结核的膀胱刺激症状不明显，尿常规、B超、静脉肾盂造影是主要的检查方法，CT具有较大的诊断价值；外科手术仍是肾结核无功能肾的主要治疗手段。

Analysis of Diagnosis and Treatment of 45 Cases of Atypical Renal Tuberculosis

Objective： To improve the diagnosis and treatment of atypical renal tuberculosis. Methods： From January 1979 to Decmeber 2009,45 cases with atypical advanced renal tuberculosis were reviewed retrospectively. All the cases about age clinical manifestations,imaging and treatmentv were discussed. Results：There were 45 cases of atypical renal tuberculosis including 24 men and 21 women,with the average age of 38 （from 19 to 61）. 38 cases （84.4%） of the ages was located in the range of 20-50 years old. 33 cases （73.3% ） were from rural areas. The course of this disease was from 3 months to 8 years （mean 28.6 months）. The clinical manifestations of most cases included urinary frequency of 31 cases（68.9%） ,gross and microscopic hematuria 9 cases （20.0%）. unusual urine routine 36 cases（80.0%）. 15 of 24 patients of the man were treatment for chronic prostatitis for 1 to 3 yeas and the patients was final diagnosis of renal tuberculosis. 7 patients of the man were tuberculosis of epididymis and three underwent epididymectomy in other hospitals. The diagnostic accuracy of urography,CT and B-type ultra-sonography were 21.2 %, 100 % and 88.9 %,respectively. Conclusions： Atypical renal tuberculosis was no typical irritation sign of bladder. The main diagnostic methods are routine uronoscopy,B-type ultrasonography and intravenous pyelography. CT is the most valuable diagnostic method for atypical renal tuberculosis. Surgery operation for non-functioning kidney is still mainly therapeutic methods.