中晚期肾结核的临床诊治分析

发布时间：2018-02-11 21:01

本文关键词： 肾结核诊断治疗　出处：《宁夏医科大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：探讨中晚期肾结核的临床表现、诊断和治疗方法。方法：宁夏医科大学总医院泌尿外科自2006年1月至2011年12月共收治中晚期肾结核89例,回顾性分析这些患者的年龄分布、临床表现、实验室检查、影像学检查及治疗的方法等临床病例资料，探讨中晚期肾结核的临床诊治特点。结果：男性36例(40.5%)，女性53例(59.5%)，膀胱刺激症状46例(48.3%),肉眼血尿21例(23.5%),尿失禁3例（3.4%）,肾区疼痛38例(42.6%)，，消瘦和/或盗汗26例(29.2%)。尿常规异常43例(48.3%),血沉检查阳性率为41.1%；尿抗酸杆菌阳性率为11.1%；B超、IVP、CT和CTU诊断符合率分别为31.2%、40.0%、62.5%、73.9%。结论：对于临床怀疑肾结核的病人建议灵活、综合运用IVU、CT、肾动态显像检查，密切结合临床，能做出正确诊断。如患者确定为中重度肾结核，应在抗结核治疗2周后，宜早期行患侧肾脏及输尿管切除术治疗。结核肾切除可以缩短抗结核疗程，极大减少抗结核药物毒副作用、结核菌耐药性的产生和结核病复发的机会。随着腹腔镜技术的发展以及腹腔镜手术医师经验的积累和技术的提高，后腹膜腔镜下肾切除手术有可能作为中重度肾结核的首选治疗方法。
[Abstract]:Objective: to investigate the clinical manifestation, diagnosis and treatment of advanced renal tuberculosis. Methods: from January 2006 to December 2011, 89 patients with advanced renal tuberculosis were treated in Urology Department, General Hospital of Ningxia Medical University. The age distribution, clinical manifestation and laboratory examination of these patients were analyzed retrospectively. To investigate the clinical diagnosis and treatment of advanced renal tuberculosis. Results: there were 36 males, 53 females, 59.5U, 46 patients with bladder irritation, 21 patients with naked hematuria, 23.5 patients with hematuria, 3 patients with urinary incontinence, 38 patients with renal pain, 26 patients with wasting and / or night sweating. The positive rate of urinary acid-fast bacilli was 11.1%, and the diagnostic coincidence rate of CT and CTU was 31.22.20% and 62.5% 73.9%, respectively. Conclusion: for patients with suspected renal tuberculosis, it is suggested to be flexible, comprehensive use of IVUCT, renal dynamic imaging, closely combined with clinical, can make a correct diagnosis. If the patient is identified as moderate and severe renal tuberculosis, should be treated with anti-tuberculosis 2 weeks after treatment, Nephrectomy can shorten the course of antituberculous treatment and greatly reduce the toxicity and side effects of antituberculous drugs. With the development of laparoscopic techniques and the accumulation of experience and techniques of laparoscopic surgeons, Retroperitoneal nephrectomy may be the first choice in the treatment of moderate and severe renal tuberculosis.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R527.1

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