發(fā)布時間：2018-04-06 05:18

  本文選題：腎臟結(jié)核　切入點：新時期　出處：《遵義醫(yī)學(xué)院》2013年碩士論文

【摘要】：目的：評估新時期臨床型腎結(jié)核的臨床特點和診斷方法,以提高腎結(jié)核的診斷水平。 方法：回顧性研究分析遵義醫(yī)學(xué)院第一附屬醫(yī)院泌尿外科于2009年1月～2012年1月收治的腎結(jié)核患者51例,其中男性21例,女性30例。左腎結(jié)核21例,右腎結(jié)核26例,雙腎結(jié)核4例。腎結(jié)核伴同側(cè)輸尿管結(jié)核31例,伴肺結(jié)核10例,伴膀胱結(jié)核3例,伴腹腔結(jié)核2例,伴附睪結(jié)核1例。分別從臨床表現(xiàn)、實驗室檢查及影像學(xué)檢查方面分析總結(jié)了全部病例的臨床特點。 結(jié)果：腎結(jié)核以20-50歲年齡段發(fā)病率最高,其典型臨床特征為膀胱刺激癥狀：尿頻、尿急、尿痛,發(fā)生率分別為52.9%(27/51)、49.0%(25/51)、41.2%(21/51)。除此之外,主要表現(xiàn)為腰痛、血尿和膿尿,發(fā)生率分別為58.8%(30/51)、33.3%(17/51)和54.9%(28/51)。僅有3.9%(2/51)的患者表現(xiàn)為發(fā)熱、盜汗等結(jié)核感染癥狀。合并肺結(jié)核比例占19.6%(10/51),不典型腎結(jié)核病例29例,占56.9%(29/51)。12例尿沉渣抗酸染色陽性,占23.5%(12/51)。B超檢查、KUB+IVU檢查、CT檢查診斷符合率分別為50.0%(23/46)、24.4%(11/45)、67.0%(18/27)。49例術(shù)前診斷為腎結(jié)核,占96.1%(49/51),誤診為腎積水1例,腎萎縮1例。51例患者均接受腎輸尿管切除術(shù),術(shù)后病檢結(jié)果均證實為腎結(jié)核。術(shù)后均規(guī)律抗癆治療6個月。術(shù)后獲得隨訪25例至今,恢復(fù)良好,復(fù)查尿常規(guī)均正常,臨床癥狀消失,無不適主訴。影像學(xué)檢查20例未見復(fù)發(fā)。 結(jié)論： 1.腎結(jié)核發(fā)病高峰年齡為20-50歲,有后移趨勢。 2.不典型腎結(jié)核病例增多。 3.B超診斷腎結(jié)核陽性率低,缺乏特異性；IVU僅對早期腎結(jié)核有特異性表現(xiàn)；CT對腎結(jié)核病變敏感,特異性高,可作為診斷腎結(jié)核的“金標(biāo)準(zhǔn)”。 4.凡懷疑腎結(jié)核患者,均應(yīng)常規(guī)行尿常規(guī)檢查、尿涂片找抗酸桿菌和腎臟CT檢查,綜合分析。
[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.鍚堝茍鑲虹粨鏍告瘮渚嬪崰19.6%(10/51),涓嶅吀鍨嬭偩緇撴牳鐥呬緥29渚，

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