输尿管镜活检术在不典型泌尿系结核诊断中的应用价值

Clinical value of ureteroscopy and mucosa biopsy in the diagnosis of atypical urinary system tuberculosis

目的探讨输尿管镜活检术在不典型泌尿系结核诊断中的临床应用价值。方法回顾分析11例泌尿系结核患者的临床资料及其应用输尿管镜活检术诊断的结果,并与同期进行的尿沉渣抗酸杆菌检测和泌尿系影像学检查结果进行比较。结果所有的患者均加行输尿管镜活检术,结果11例中有8例活检病理诊断证实为输尿管结核或结核性膀胱炎,诊断阳性率为72.72%,高于同期的尿沉渣抗酸杆菌检查诊断的4例(36.37%阳性率)和泌尿系影像学检查诊断的6例(54.54%阳性率);11例中还有3例输尿管镜活检术诊断为输尿管黏膜慢性炎症,考虑患肾已无功能,最后均予患肾及部分输尿管切除,术后病理证实为泌尿系结核。所有输尿管镜活检术后的病例均无严重并发症发生。结论输尿管镜活检不失为一种有效、较特异和安全的诊断泌尿系结核的方法之一。

Objective To evaluate the clinical value of ureteroscope and mucosa biopsy in the diagnosis of atypical urinary system tuberculosis.Methods The clinical data of 11 patients underwent ureteroscope and mucosa biopsy were observed,in comparison with urinary urine acid fast bacilli（AFB） detection and urinary radiology taken simultaneously.Results All the patients were received biopsies of the mucous membrane of ureter with ureteroscopy,eight of eleven patients（72.72%） were precisely diagnosed as suffering from ureter tuberculosis or tubercular cystitis,the positive rate is higher than those of urinary urine acid fast bacilli（AFB） detection（36.37%）and urinary radiology detection（54.54%）.Three of eleven cases（27.28%） were diasgnosed as chronic inflammation of the mucous membrane of ureter or bladder,but finally diagnosed as renal tuberculousis after nephro～ureterectomy.There were no severe complications.Conclusions It was regarded that ureteroscope and mucosa biopsy is one of effective and safe methods for the diagnosis of urinary system tuberculosis