不典型肾结核29例临床分析

Clinical study of 29cases of atypical renal tuberculosis

目的：探讨不典型肾结核的诊断和治疗。方法：回顾性分析29例不典型肾结核患者的临床资料：29例患者行尿常规、血沉（ESR）、抗结核抗体（TB-Ab）实验室检查以及B超、IVU、CT影像学检查;15例行异烟肼＋利福平＋吡嗪酰胺/乙胺丁醇药物治疗,14例行手术治疗。结果：尿常规、ESR、TB-Ab阳性率分别为55.17%、44.44%、50.00%,B超、IVU、CT诊断符合率分别为10.34%、28.57%、68.97%;14例术后病理检查均符合典型结核病变,15例药物治疗者均治愈,14例手术治疗者随访6个月~2年均治愈。结论：B超检查适用于门诊筛选和术后复查。CT和IVU对不典型结核诊断价值很高。实验室联合影像学检查可提高诊断效率。早期肾结核可行药物治疗,中晚期肾结核以肾切除为主,切除范围尽量包括肾周脂肪及严重病变的输尿管。

Objective：To study the diagnosis and treatment of atypical renal tuberculosis（TB）.Method：Clinical data of 29 cases of atypical renal TB were analyzed retrospectively.All patients received several examinations including routine urine test,erythrocyte sedimentation rate（ESR）,tuberculosis antibody（TB-Ab）,B-type ultrasonography,intravenous urography（IVU）,and CT.Fifteen patients were treated with antituberculous chemotherapy（INH＋RFP＋PZA/EMB）,and 14 received surgery.Result：The diagnostic positivity rate were 44.44%and 50%for ESR and TB-Ab,55.17%for routine urine test.The diagnostic accuracy of B-type ultrasonography,IVU and CT were 10.34%,28.57% and 68.97%,respectively.The results of pathology showed the typical TB was seen in 14 patients.Patients undergoing antituberculous chemotherapy were cured and patients undergoing operation were cured over the follow-up period of 6-24 months.Conclusion：B-type ultrasonography is suitable for outpatient screening and post-operation review.CT and IVU play an essential role in diagnosis.Laboratory tests combined with imaging studies would help to assess the diagnosis of atypical renal TB.Antituberculous chemotherapy is valid for early period of renal TB.The non-functioning kidney,perirenal fat and involved ureter should be resected during mid-later period of renal TB.