脊柱结核合并肾结核的临床特点及诊断治疗

目的：探讨脊柱结核合并肾结核的l临床特点及脊柱结核与肾结核二者外科治疗间的相互关系。方法：对我科1963～2000年间收治的30例脊柱结核合并肾结核患者的临床表现及诊断治疗进行回顾性分析。结果：30例脊柱结核合并肾结核者全部为18岁以上成年人。骨病灶相对集中于胸腰段及其上下椎体。临床症状以脊柱结核症状为主，而肾结核l临床症状多不典型。均行3～4联抗痨药物规范治疗，手术治疗23例，保守治疗7例。除术中死亡1例外，余29例随访1～10年，平均3年，病变治愈者28例，1例截瘫者大部分恢复，但仍需扶拐行走。结论：脊柱结核合并肾结核者肾结核的临床症状多不典型，易漏诊。脊柱结核伴尿常规异常者应警惕有合并肾结核之可能。脊柱结核合并肾结核的外科治疗应在规范化疗支持下进行，如骨、肾病变均需外科治疗，不论同期或分期手术，均以先处理肾脏病变为宜。

Clinical characteristics,diagnosis and treatment of spinal tuberculosis combined with renal tuberculosis

Objective:To explore clinical characteristics of spinal tuberculosis combined with renal tuberculosis,namely,correlation of surgical treatment of spinal tuberculosis with renal tuberculosis.Method:In this retrospective study,the authors reviewed the presentations,diagnosis and management in30patients suffered from spinal tuberculosis combined with renal tuberculosis between1963and2000.Result:30cases of spinal tuberculosis combined with renal tuberculosis were all older than18years.The bone lesions involved the vertebrae mostly around the thoracolumbal segment.The clinical symptoms of spinal tuberculosis were predominant,but those of renal tuberculosis were often nonspecific.All the patients were treated by regular3-4drug combination antituberculosis therapy,and23cases were treated operatively and7cases conservatively.Of all the patients,1case was dead during operation,and29cases was followed up for1-10years(average3years),of whom28cases were healed,and1case who was complicated with paraplegia was nearly recovered,although need walk on crutches.Conclusion:The symptoms of renal tuberculosis in spinal tuberculosis combined with renal tuberculosis are often atypical,and easily overlooked.Abnormal urine routine results associated with spinal tuberculosis alert the clinician to the presence of renal tuberculosis.The surgical treatment of spinal tuberculosis combined with renal tuberculosis should be conducted on the basis of regular chemotherapy.When lesions in both spine and kidney need to be treated by operation,it may be proper that the renal operation is performed in the first stage.