【摘要】目的:探讨中晚期肾结核的诊断和治疗方法。方法:回顾性分析30例中晚期肾结核的临床资料。结果:下尿路刺激症状18例(60%),血尿8例(26.7%),腰痛6例(20%),尿常规异常28例(93.3%),尿抗酸杆菌阳性率8例(26.7%),B超,IVU,CT诊断符合率分别为30%,53.3%,80%。6例行抗结核保守治疗,20例行患肾加输尿管切除术,4例行无功肾切除,对侧输尿管腹壁造口术。结论:尿常规异常伴反复发作的下尿路刺激症状应高度怀疑肾结核,尿抗酸杆菌检查可作为初步筛查,B超,IVU,CT可作为首选影像学检查,CT在晚期肾结核诊断上更有优势,治疗以患肾加输尿管切除为主,应尽可能切除患侧输尿管全长,术后应抗结核治疗6个月或更长。

    【关键词】肾结核;诊断;治疗

    Diagnosis and Treatment of Advanced Renal Tuberculosis: 30 Cases Report

    Sun HongWei

    【Abstract】Objective : To explore the diagnosis and treatment of the advanced renal tuberculosis. Methods: The clinical data of 30 cases of advanced renal tuberculosis were analyzed retrospectively. Results: Irritation symptoms,gross hematuria and flank pain were found in 18 cases(60%) , 8 cases (26.7%) and 6 cases(20%), repectively. Abnormal urine test and acid positive fast stains on urinary sediment were detected in 28 cases(93.3%)and 8 cases(26.7%). The diagnost ic accuracy of B type ultrasonography, IVU and CT in these patients were 30 %, 53.3 % and 80%. 20 and 4 patients underwent nephrectomy and ureter-abdomen ostomy, respectively. Conclusion: B-type ultrasonography, IVU and CT are the of great importance in imaging diagnosis. Nephrectomy and partial ureterectomy is considered as the first choice of surgery after regular chemotherapy. ......