45例肾结核的外科诊治经验

Surgery for renal tuberculosis:clinical analysis of 45 cases

目的 :为了提高肾结核的诊治水平。方法 :研究诊治 45例肾结核的经验。结果 :45例中尿路刺激症状合并血尿者占 71 .1 % ,无症状者占 2 6.7% ;尿抗酸杆菌阳性率为 2 6.7% ;IVP、逆行尿路造影和 CT诊断符合率分别为 31 .7%、41 .2 %、64.5%。45例中有 4例肾功能不全患者经核磁共振 (MRI)检查均诊断为肾结核。 45例中 40例行肾和部分输尿管切除 ,4例肾功能不全患者先行肾造瘘术后待肾功能改善分次行患肾切除术和结肠膀胱扩大术 ,1例抗结核治疗半年后随访因患肾功能严重损害而行患肾切除。全部患者术后行病理检查证实为肾结核。结论 :凡有膀胱刺激征合并血尿和尿常规异常者可认为是诊断肾结核的主要线索 ;尿抗酸杆菌、IVP、逆行尿路造影和 CT是诊断肾结核的主要方法 ;MRI对肾功能不全的肾结核患者的诊断有帮助。抗结核治疗需严密随访 ,对肾脏破坏严重或无功能肾应行手术切除。

Objective:To improve the diagnostic and therapeutic level for renal tuberculosis.Methods:Clinical data of 45 cases were analyzed retrospectively.Results:The clinical characteristics of 45 cases were :urinary irritation with gross hematuria,71.1%;asymptom,26.7%;positive acid fast stain,26.7%.The diagnostic accuracy of IVP,retrograde urography and CT were 31.7%,41.2%and 64.5% respectively.Four patients associated with renal failure were made a definite diagnosis by MRI.Forty patients received primary nephrectomy and partial ureterectomy,4 cases with renal failure underwent secondary nephrectomy and cystectasis,and one with early renal tuberculosis had to be operated after 6 months of conservative therapy.Renal tuberculosis in 45 cases was confirmed by postoperative pathological examination.Conclusion:Urinary irritation with gross hematuria and abnormal urine analysis should be considered as the important clue to renal tuberculosis.Acid fast stain,IVP,retrograde urography and CT are the main diagnostic methods,whereas MRI is helpful in the diagnosis of renal tuberculosis accociated renal failure.The patients must be carefully followed up during antiphthisic treatment.Seriously damaged or non functioning kidney should be promptly removed.