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目的:探讨肾结核的临床特点及诊治方法方法:回顾性分析1999年1月至2009年12月梅州市人民医院收治的105例肾结核患者的临床资料。结果:105例患者最常见的临床表现为膀胱刺激征(尿频、尿急、尿痛)和腰痛,分别为68.6%(72/105)和51.4%(33/105):27例患者症状不典型各种检查手段的阳性率分别是:尿抗酸杆菌阳性率28.2%(20/71)、尿TB-PCR阳性率57.5%(46/80);IVU诊断肾结核阳性率48.3%(42/87)、B超诊断肾结核阳性率23.7%(23/97)、CT诊断肾结核阳性率80.4%(74/92)。药物治疗47例中42例药物治疗后12～18个月尿液检查正常,B超或IVU显示病灶稳定或消失;5例肾结核在药物治疗6～12个月后无效或恶化,改行患肾切除。58例手术治疗中53例同时施行患侧输尿管切除术,术后病理诊断证实均为肾结核,随访1～3年无复发无转移。结论:尿TB-PCR阳性和IVU是目前诊断肾结核的主要手段,CT有一定的辅助诊断价值。临床肾结核发生率无明显下降,但并发症发生率明显下降,抗结核药物治疗效果显著增加。肾结核肾切除术应尽可能切除患侧输尿管。
Objective: To investigate the clinical characteristics of renal tuberculosis and diagnosis and treatment methods: a retrospective analysis of clinical data of 105 cases of renal tuberculosis patients admitted to Meizhou People’s Hospital from January 1999 to December 2009. Results: The most common clinical manifestations in 105 patients were bladder irritation (urinary frequency, urgency, dysuria) and low back pain, which were 68.6% (72/105) and 51.4% (33/105), respectively. 27 patients had atypical symptoms The positive rates of various methods were 28.2% (20/71) of urine acid-fast bacilli and 57.5% (46/80) of urine TB-PCR. The positive rate of IVU diagnosis of renal tuberculosis was 48.3% (42/87) ). The positive rate of B-ultrasonography in diagnosis of renal tuberculosis was 23.7% (23/97). The positive rate of CT diagnosis in renal tuberculosis was 80.4% (74/92). 42 cases of drug treatment in 47 cases of 12 to 18 months after treatment, urine tests were normal, B-or IVU showed stable or disappeared lesions; 5 cases of renal tuberculosis in drug treatment 6 to 12 months after the invalid or worse, diverted to the kidney resection. In the 58 cases of operation, 53 cases underwent ipsilateral ureteral resection at the same time. The postoperative pathological diagnosis was renal tuberculosis. No recurrence was found in 1 to 3 years follow-up. Conclusion: Urine TB-PCR positive and IVU are the main methods of diagnosis of renal tuberculosis. CT has some diagnostic value. The incidence of clinical renal tuberculosis no significant decline, but the incidence of complications decreased significantly, the anti-TB drug treatment effect was significantly increased. Renal tuberculosis should be resected as far as possible ipsilateral ureteral ureter.