新时期临床型肾结核的临床特点和诊断分析（附51例报告）

发布时间：2018-04-06 05:18

  本文选题：肾脏结核　切入点：新时期　出处：《遵义医学院》2013年硕士论文

【摘要】：目的：评估新时期临床型肾结核的临床特点和诊断方法,以提高肾结核的诊断水平。 方法：回顾性研究分析遵义医学院第一附属医院泌尿外科于2009年1月～2012年1月收治的肾结核患者51例,其中男性21例,女性30例。左肾结核21例,右肾结核26例,双肾结核4例。肾结核伴同侧输尿管结核31例,伴肺结核10例,伴膀胱结核3例,伴腹腔结核2例,伴附睾结核1例。分别从临床表现、实验室检查及影像学检查方面分析总结了全部病例的临床特点。 结果：肾结核以20-50岁年龄段发病率最高,其典型临床特征为膀胱刺激症状：尿频、尿急、尿痛,发生率分别为52.9%(27/51)、49.0%(25/51)、41.2%(21/51)。除此之外,主要表现为腰痛、血尿和脓尿,发生率分别为58.8%(30/51)、33.3%(17/51)和54.9%(28/51)。仅有3.9%(2/51)的患者表现为发热、盗汗等结核感染症状。合并肺结核比例占19.6%(10/51),不典型肾结核病例29例,占56.9%(29/51)。12例尿沉渣抗酸染色阳性,占23.5%(12/51)。B超检查、KUB+IVU检查、CT检查诊断符合率分别为50.0%(23/46)、24.4%(11/45)、67.0%(18/27)。49例术前诊断为肾结核,占96.1%(49/51),误诊为肾积水1例,肾萎缩1例。51例患者均接受肾输尿管切除术,术后病检结果均证实为肾结核。术后均规律抗痨治疗6个月。术后获得随访25例至今,恢复良好,复查尿常规均正常,临床症状消失,无不适主诉。影像学检查20例未见复发。 结论： 1.肾结核发病高峰年龄为20-50岁,有后移趋势。 2.不典型肾结核病例增多。 3.B超诊断肾结核阳性率低,缺乏特异性；IVU仅对早期肾结核有特异性表现；CT对肾结核病变敏感,特异性高,可作为诊断肾结核的“金标准”。 4.凡怀疑肾结核患者,均应常规行尿常规检查、尿涂片找抗酸杆菌和肾脏CT检查,综合分析。
[Abstract]:Objective: to evaluate the clinical features and diagnostic methods of clinical renal tuberculosis in order to improve the diagnostic level of renal tuberculosis.Methods: a retrospective analysis of 51 patients with renal tuberculosis in Urology Department of the first affiliated Hospital of Zunyi Medical College was conducted from January 2009 to January 2012, including 21 males and 30 females.There were 21 cases of left renal tuberculosis, 26 cases of right renal tuberculosis and 4 cases of double kidney tuberculosis.There were 31 cases of renal tuberculosis associated with ipsilateral ureteral tuberculosis, 10 cases of pulmonary tuberculosis, 3 cases of bladder tuberculosis, 2 cases of abdominal tuberculosis and 1 case of epididymal tuberculosis.The clinical features of all cases were analyzed and summarized from clinical manifestation, laboratory examination and imaging examination.Results: the incidence of renal tuberculosis was the highest in the 20-50 age group. The typical clinical features were bladder irritation symptoms: frequent urination, urinal urgency, and urinal pain. The incidence of renal tuberculosis was 52.9%. The incidence of renal tuberculosis was 49.0%, 41.2% and 21 / 51%, respectively.In addition, the main manifestations were low back pain, hematuria and pyuria, the incidence of which was 58.8% or 33.3% or 33.3% / 51% and 54.9% / 51%, respectively.Only 3.9% of the patients showed symptoms of tuberculosis infection, such as fever, night sweats and so on.鍚堝苟鑲虹粨鏍告瘮渚嬪崰19.6%(10/51),涓嶅吀鍨嬭偩缁撴牳鐥呬緥29渚，

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