泌尿系结核32例诊断体会

Diagnostic experiences on 32 cases of urinary tuberculosis

目的提高泌尿系结核的诊断水平。方法回顾性分析32例泌尿系结核的临床资料,总结其诊断经验。结果最常见的主诉为尿路刺激征(66%)和肉眼或镜下血尿(34%)。尿沉渣涂片找抗酸杆菌和尿PCR TBDNA阳性率分别为22%和30%;静脉尿路造影(IVU)、逆行肾盂造影、CT的确诊率分别为30%、27%和58%。32例患者接受手术治疗,且术后病理检查均证实为泌尿系结核。结论泌尿系结核的临床诊断应综合病史尿液分析、影像学检查、病原学诊断等多种方法,力求寻找更多证据。X线检查应首选IVU和逆行肾盂造影,对两者未能明确诊断者可选择CT检查。对于中、晚期肾结核,CT的诊断价值较逆行肾盂造影更大。

Objective To improve the diagnostic accuracy for urinary tuberculosis （TB）. Methods Reviewed the clinical data of 32 cases of urinary TB and summarizd the clinical diagnostic experiences. Results Vesical irritative symptoms（66% ）and gross or microscopic hematuria（34% ）were the most common symptoms seen in these patients. Acid - fast stains on urinary sediment were positive in 22% of cases and PCR TBDNA positive in 30%. The diagnostic accuracy of 1VU,retrograde pyelography and CT in these patients were respectively 30% ,27% and 58%. 32 patients received surgery treatment. All 32 cases of urinary tuberculosis were confirmed by the postop- erative pathological examinations. Conclusion The patient history, urine analysis ,the image evaluation and pathological detection should be combined in the clinical diagnosis for urinary tuberculosis. The IVU and retrograde pyelography should be the first choice for evaluation of urinary TB. For difficult and undefined cases with use of the both methods, CT might be a selection. For mid to end stage urinary tuberculosis, CT is more valuable than the retrogradeurography in the diagnosis for urinary tuberculosis.