临床期肾结核治疗的回顾性研究（附55例分析）

发布时间：2019-01-14 15:41

【摘要】：目的：回顾性分析55例临床型肾结核的病历资料,探讨临床型肾结核的典型症状与诊疗技术变化趋势；比较后腹腔镜与开放手术的治疗效果,为后腹腔镜下结核肾切除术的临床应用提供理论参考。资料和方法：统计遵义医学院附属医院泌尿外科2009年1月至2012年1月收治的89例肾结核患者病历资料。术后病理确诊为肾结核的55例(年龄、性别、临床表现、辅助检查、治疗方式、病理类型、随访)纳入统计分析。按手术方式不同分为两组,应用平均值、构成比、率等对各项指标进行统计学分析。结果：肾结核住院人数及手术例数呈逐年增加趋势,仍以青壮年多见,年龄主要集中在20-40岁间,10例可以找到肺结核的依据。临床症状中典型症状者占36.4%(20/55),不典型症状者占54.5%(30/55),无任何症状者占9.1%(5/55)。55例患者均无明显体重下降。B超提示肾结核占49.1%(27/55),CT诊断肾结核占66.6%(18/27),KUB+IVU检查提示肾结核占26.5%(13/49),胸部正位片提示肺结核占18.2%(10/55)。所有患者术前规律服用抗结核药两周以上,其中开放手术41例,腹腔镜手术14例,腹腔镜组在术中出血、术后肠功能恢复、下床活动时间、住院天数指标中均优于开放手术组,但在手术时间,住院总费用指标中开放手术组占优。55例术后病理：肾、输尿管结核,术后均康复出院。29例定期于我院门诊复查并获随访,26人失访,平均随访时间为12个月(6个月至3年),随访率52.7%。结论：1.肾结核发病年龄仍集中在20-40岁；2.典型病例逐渐减少；3.尿找抗酸杆菌的特异性高,但阳性率低；4.B超、CT是诊断肾结核的主要辅助检查；5.腔镜下结核肾切除术具有创伤小、出血少、术后康复快等优势；6.泌尿、生殖系结核抗结核治疗6个月以上为宜。
[Abstract]:Objective: to retrospectively analyze the medical records of 55 cases of clinical renal tuberculosis and to explore the typical symptoms and the trend of diagnosis and treatment of clinical renal tuberculosis. To compare the therapeutic effect of retroperitoneal laparoscopy and open surgery, to provide theoretical reference for the clinical application of retroperitoneal laparoscopic nephrectomy of tuberculosis. Materials and methods: the medical records of 89 patients with renal tuberculosis admitted from January 2009 to January 2012 in Urology Department affiliated Hospital of Zunyi Medical College were analyzed. 55 cases (age, sex, clinical manifestation, adjuvant examination, treatment mode, pathological type, follow-up) of renal tuberculosis diagnosed by postoperative pathology were included in statistical analysis. According to the different operation methods, the two groups were divided into two groups. The average value, composition ratio, rate and so on were analyzed statistically. Results: the number of patients with renal tuberculosis and the number of cases of operation were increasing year by year. The age was mainly between 20 and 40 years old. The evidence of pulmonary tuberculosis could be found in 10 cases. Typical symptoms were 36.4% (20 / 55) and atypical symptoms were 54.5% (30 / 55). There was no significant weight loss in 55 patients. B ultrasound showed that renal tuberculosis accounted for 49.1% (27 / 55), CT accounted for 66.6% (18 / 27). KUB IVU revealed renal tuberculosis in 26. 5% (13 / 49) and chest radiography in 18. 2% (10 / 55). All the patients took anti-tuberculosis drugs regularly for more than two weeks before operation, including 41 cases of open surgery and 14 cases of laparoscopic surgery. The indexes of bleeding during operation, recovery of intestinal function after operation, time of getting out of bed and hospital stay in laparoscopy group were better than those in open operation group. But in the operation time, the total cost of hospitalization in the open operation group was the dominant. 55 cases of postoperative pathology: renal and ureteral tuberculosis, all recovered and discharged after operation. 29 cases were regularly re-examined and followed up in our outpatient clinic, 26 cases were not visited. The mean follow-up time was 12 months (6 months to 3 years), and the follow-up rate was 52.7%. Conclusion: 1. The onset age of renal tuberculosis is still concentrated in 20-40 years old; 2. 5%. Typical cases gradually decreased; 3. The specificity of urinary acid-fast bacilli was high, but the positive rate was low. 4.B ultrasound, CT was the main auxiliary examination for diagnosis of renal tuberculosis. Endoscopic nephrectomy has the advantages of less trauma, less bleeding and quick postoperative recovery. 6. Urinary, genital tuberculosis anti-tuberculosis treatment for more than 6 months is appropriate.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R527.1

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