中晚期肾结核临床分析(附37例报告)

目的探讨中晚期肾结核的临床特点和治疗。方法回顾分析37例中晚期肾结核患者的临床资料。结果近年来不典型肾结核病明显增加，该组临床症状以腰痛、尿频、发热和血尿为主；尿查抗酸杆菌和尿PCR-TB-DNA阳性率分别为9．09％和15．38％；B超、KUB加IVU、逆行肾孟造影、CT确诊率分别为45．90％、78．39％、44．44％和60．00％。37例病人均经手术治愈(术前、术后应用雷米封、利福平、吡嗪酰胺三联治疗)，术后病理均证实为肾结核。结论不典型肾结核其临床特征与文献报道有明显差异。临床诊断应结合病史、尿液分析、影像学检查、病源学诊断等多种方法。对于中晚期肾结核肾切除时应尽可能切除患侧输尿管，短程三联治疗效果满意。

Clinical analysis of mid-advanced renal tuberculoses (report of 37 cases)

To discuss the clinical characteristics and treatment of mid-advanced renal tuberculoses. Retrospective analysis of the clinical date of 37 cases. The numbers of atypical renal tuberculoses were obviously increased recently. The clinical symptoms of these patients were mainly loin pain, urinary frequency, fever and hematuria. Acid fast stains on urinary sediments were positive in 9.09% of cases and PCR-TB-DNA positive in 15.38%. The diagnostic accuracy of B-type ultrasonography, intravenous pyelography, retrograde pyelography and CT were 45.90%, 78.39%, 44.44% and 60.00% respectively. All of 37 cases were cured by surgery and drug(INH+RFP+PZA before or after operation) treatment. And renal tuberculoses were confirmed by the postoperative pathological examination. [Conclusions] The incidence of atypical renal tuberculoses has increasing trend and its clinical feature is abviously different from that of typical renal tuberculoses. The patient history, urine analysis, the image evaluation and pathogen-detection should be combined in the clinical diagnosis for renal tuberculoses. For mid-advanced renal tuberculoses, when nephroureterectomy is indicated, the involved ureter should be excised as much as possible. INH, RFP and PZA used combinedly yield satisfactory outcome.