72例近期肾结核诊断和治疗

Diagnosis and Treatment of 72 Cases of Renal Tuberculosis

目的 :提高肾结核的诊治水平。方法 :总结了近期 72例患者的诊治经验。结果 :尿路刺激症状和血尿为最常见的症状 ,分别为 91%和 4 8%。 2 4h尿抗酸杆菌的阳性率为4 8%。B超、IVU、逆行尿路造影及CT的诊断符合率分别为 4 0 %、6 0 %、39%和 4 3%。 5 9例接受肾及部分输尿管切除术。结论 :B超、IVU和逆行尿路造影可作为泌尿系结核诊断首选的影像学检查。尿沉渣染色查抗酸杆菌仍应作为肾结核诊断的重要方法。必要时结合CT及磁共振水成像检查 。

Objective:To improve the diagnostic technique and therapeutic efficacy for renal tuberculosis.Methods:Retrospective analysis of the clinical data of renal tuberculosis.Results:Irritative symptoms(91%)and gross hematuria(36%)were the most common symptoms encountered in these patients.Acid-fast stains on urinary sediment were positive in 48% of cases.The diagnostic accuracy of B-ullraconography,IVU,retrograde urography and CT in these patients were 40%,60%,39% and 43% respectively.59 patients underwent a nephrectomy and partial ureterectomy.Conclusions:B-ultraconography,IVU and retrograde urography are the first-line studies in the evaluation of urinary tuberculosis.Acid-fast stain remains a major pathogen-detecting tool.CT scanning or MRI have a definite value in the diagnosis of moderate and late stage of the disease.For tuberculosis of kidney and ureter,total ureterectomy might not be needed.When surgical intervention is needed,nephrectomy and partial ureterectomy world be enough.