不典型晚期肾结核的诊断分析(附78例报告)

Clinical analysis of atypical advanced renal tuberculoses

目的 :探讨不典型晚期肾结核的临床特点和主要诊断方法。方法 :对 1980～ 1999年间收治的 78例不典型晚期肾结核患者进行回顾性分析。 78例患者中 ,尿常规检查 69例、尿找结核杆菌 2 2例 ,KUB检查 74例 ,IVU检查 73例 ,CT检查 17例 ,B超检查 64例 ;作一侧肾切除 69例 ,药物治疗加对侧肾造口 5例 ;单纯药物治疗 4例。结果 :78例均获随访 ,随访时间为 0 .5～ 3年。 69例经手术治愈 ,术后经病理检查证实为肾结核 ;9例未做手术者分别于 0 .5～ 2年内死亡。结论 :在经济欠发达地区 ,不典型晚期肾结核仍不少见 ;尿检结核杆菌或PCR TB DNA检查阳性率低 ;B超可作为筛选肾结核的检查手段 ,确诊仍需作KUB加IVU及CT检查。

Purpose: To discuss the clinical characteristics and diagnostic techniques of atypical advanced renal tuberculosis.Methods: Clinical data of 78 cases of atypical renal tuberculosis treated between 1980 to 1999 were reviewed.Results: Clinical characteristics of advanced renal tuberculosis were not typical. Irritative symptoms, gross hematuria and lumbago were the most common symptoms. Part of the patients only complained about other system symptoms, such as cough, abdominalgia, ect. 69 cases were cured by surgery and drug treatment. 5 of 9 cases who received nephrestomy died within six months to two years after antituberculesis treatment because of severe damage of kidney.Conclusions: Atypical advanced renal tuberculosis are not scarce in the developing area. The positive rates of urine bacillus tuberculosis examination and PCR are low. Patients with renal tuberculosis can be screened by B-ultrasonography. Most of the cases can be diagnosed definitely by intravenous pyelography and CT scan.