肾结核74例诊治分析

The Analysis of Treatment and Diagnosis of Renal Tuberculosis

目的提高肾结核的诊断和治疗水平。方法回顾性分析74例肾结核患者的临床资料。结果尿频、尿痛和血尿是最常见的症状,分别为55.6%(41/74例)、43.2%(32/74例)、47.2%(35/74例)。红细胞沉降率增快54例,尿检红细胞阳性率64.9%(48/74),白细胞阳性率54.1%(40/74)、尿蛋白阳性率60.8%(45/74)、脓尿33.8%(25/74);24小时尿沉渣找抗酸杆菌阳性率23.2%。尿PCR找抗酸杆菌DNA阳性73.0%(27/37)。影像学检查B超、IVP、CT、和MRU诊断符合率分别为31.1%、37.7%、73.8%、68.4%。经药物治疗治愈24例,50例行外科干预术后随访1～2年均治愈,其中行一侧肾切除34例,乙状结肠膀胱扩大术2例,肾造瘘5例,置输尿管支架管10例。结论肾结核的诊断主要依靠临床表现、实验室检验和影像学检查。其治疗应根据患者病情和肾脏破坏情况给予个体化治疗。

Objective To improve the diagnosis and treatment of renal tuberculosis. Methods The clinical data of 74 cases of renal tuberculosis patients were analysizcd retrospectively. Results 55.6% （41/74 cases） had urinary frequency,43.2% （32/74 cases） had odynuria and 47.2% （35/74 cases） had hematuria. These three symptoms were more common. 73.0% （54/ 74 cases） had abnormal erythrocyte sedimentation rate. 64.9% （48/74） had positive red blood cell number in urine,54.1% （40/74） had positive white blood cell number in urine, 60.8% （45/74） had positive urinary protein, 33.8% （ 25/74 ） pyuria. 23.2% were found acid-fast bacilli in 24-hour urine sediment. 73.0% （ 27/37 ） were positive urine acid-fast bacilli by PCR DNA. The diagnostic coincidence rate of B-ultrasound imaging examination, IVP, CT, and MRU were 31.1% , 37.7% ,73.8% , 68.4% respectively. 24 cases were cured by medication,50 cases were carried by routine surgical intervention and had been fol-lowed up for 1-2 years ,and no case recurred. The surgical intervention included 34 case unilateral nephrectomy ,2 case sigmoid bladder augmentation 5 case pelvis-skin fistula and 10 case putting stents in ureter. Conclusion The diagnosis of renal tubercu-losis mainly relied on clinical manifestations, laboratory tests and imaging studies. The individualized treatment should be done ac-cording to the patient＇s condition and kidney damage.