CAJ | 학술논문

目的：总结43例中晚期肾结核的诊治经验，以提高中晚期肾结核诊断准确性和治疗效果。方法回顾性分析2005年1月至2012年1月我科收治的43例中晚期肾结核患者的临床资料。结果膀胱刺激症状、肉眼血尿、腰痛为中晚期肾结核最常见临床症状，发生率分别为81．4％、65．1％、44．2％。实验室检查中，尿常规异常阳性率达90．7％，尿沉渣查抗酸杆菌有一定诊断价值。影像学检查中，CT诊断符合率最高（81．4％），同B超或泌尿系平片＋静脉肾盂造影（KUB＋IVU）比较，差异有统计学意义（P＜0．05），但同磁共振水成像（MRU）比较，差异无统计学意义（P＞0．05）。单纯抗痨治疗者5例，其中2例用药期间病情好转，但停药后加重，1例肾自截，2例无效。38例行手术治疗，其中肾切除术34例，肾及输尿管全长切除术4例；开放手术32例，腹腔镜手术6例。38例均治愈。结论泌尿系CT检查对中晚期肾结核具有较高诊断价值。中晚期肾结核大多需要手术治疗方能治愈，如对侧肾功能良好，建议切除患肾，不提倡施行肾部分切除术或脓肿穿刺引流术。
목적：총결43례중만기신결핵적진치경험，이제고중만기신결핵진단준학성화치료효과。방법회고성분석2005년1월지2012년1월아과수치적43례중만기신결핵환자적림상자료。결과방광자격증상、육안혈뇨、요통위중만기신결핵최상견림상증상，발생솔분별위81．4％、65．1％、44．2％。실험실검사중，뇨상규이상양성솔체90．7％，뇨침사사항산간균유일정진단개치。영상학검사중，CT진단부합솔최고（81．4％），동B초혹비뇨계평편＋정맥신우조영（KUB＋IVU）비교，차이유통계학의의（P＜0．05），단동자공진수성상（MRU）비교，차이무통계학의의（P＞0．05）。단순항로치료자5례，기중2례용약기간병정호전，단정약후가중，1례신자절，2례무효。38례행수술치료，기중신절제술34례，신급수뇨관전장절제술4례；개방수술32례，복강경수술6례。38례균치유。결론비뇨계CT검사대중만기신결핵구유교고진단개치。중만기신결핵대다수요수술치료방능치유，여대측신공능량호，건의절제환신，불제창시행신부분절제술혹농종천자인류술。
Objective To summarize the diagnostic and therapeutic experience of advanced renal tuberculosis , so as to in-crease diagnostic accuracy and therapeutic efficacy of advanced renal tuberculosis .Methods Clinical data of 43 cases of medium or advanced renal tuberculosis admitted into our Department from January 2005 to January 2012 were analyzed retrospectively .Results Irritation signs of bladder , gross hematuria , and lumbodynia were the most commonly-seen symptoms of advanced renal tuberculosis , with incidence rates being 81.4%, 65.1%, and 44.2% respectively.In laboratory detection, acid-fast stains on urinary sediment seemed to have diagnostic value.Medical scanning indicated that the diagnostic accordance rate of CT was the highest (81.4%), and statistical significance could be noted , when compared with ultrasonic examination or KUB +IVU(P<0.05).However, no statistical significance could be seen, when it was compared with MRU(P>0.05).Five cases underwent purely anti-tuberculosis treatment and 2 of the cases improved during medication , but were deteriorated after drug withdrawal .There was one case of autonephrectomy , and 2 cases failed to respond to anti-tuberculosis treatment .Thirty-eight patients underwent surgical treatment , of whom 34 patients underwent nephrectomy , 4 patients underwent nephroureterectomy with bladder cuff .There were 32 cases of open surgery , of which 6 cases under-went laparoscopic surgery .All the 38 cases were cured .Conclusion Urinary tract CT examination has a high diagnostic value for medi-um or advanced renal tuberculosis .Patients with medium or advanced renal tuberculosis mostly required surgical therapy for final cure of the disease.If the contralateral renal function was good , the affected kidney could be removed .And it was not advisable to perform par-tial nephrectomy or percutaneous catheter drainage of tuberculous abscess .