【摘要】：目的：回顧性分析55例臨床型腎結(jié)核的病歷資料,探討臨床型腎結(jié)核的典型癥狀與診療技術(shù)變化趨勢(shì)；比較后腹腔鏡與開(kāi)放手術(shù)的治療效果,為后腹腔鏡下結(jié)核腎切除術(shù)的臨床應(yīng)用提供理論參考。 資料和方法：統(tǒng)計(jì)遵義醫(yī)學(xué)院附屬醫(yī)院泌尿外科2009年1月至2012年1月收治的89例腎結(jié)核患者病歷資料。術(shù)后病理確診為腎結(jié)核的55例(年齡、性別、臨床表現(xiàn)、輔助檢查、治療方式、病理類型、隨訪)納入統(tǒng)計(jì)分析。按手術(shù)方式不同分為兩組,應(yīng)用平均值、構(gòu)成比、率等對(duì)各項(xiàng)指標(biāo)進(jìn)行統(tǒng)計(jì)學(xué)分析。 結(jié)果：腎結(jié)核住院人數(shù)及手術(shù)例數(shù)呈逐年增加趨勢(shì),仍以青壯年多見(jiàn),年齡主要集中在20-40歲間,10例可以找到肺結(jié)核的依據(jù)。臨床癥狀中典型癥狀者占36.4%(20/55),不典型癥狀者占54.5%(30/55),無(wú)任何癥狀者占9.1%(5/55)。55例患者均無(wú)明顯體重下降。B超提示腎結(jié)核占49.1%(27/55),CT診斷腎結(jié)核占66.6%(18/27),KUB+IVU檢查提示腎結(jié)核占26.5%(13/49),胸部正位片提示肺結(jié)核占18.2%(10/55)。所有患者術(shù)前規(guī)律服用抗結(jié)核藥兩周以上,其中開(kāi)放手術(shù)41例,腹腔鏡手術(shù)14例,腹腔鏡組在術(shù)中出血、術(shù)后腸功能恢復(fù)、下床活動(dòng)時(shí)間、住院天數(shù)指標(biāo)中均優(yōu)于開(kāi)放手術(shù)組,但在手術(shù)時(shí)間,住院總費(fèi)用指標(biāo)中開(kāi)放手術(shù)組占優(yōu)。55例術(shù)后病理：腎、輸尿管結(jié)核,術(shù)后均康復(fù)出院。29例定期于我院門(mén)診復(fù)查并獲隨訪,26人失訪,平均隨訪時(shí)間為12個(gè)月(6個(gè)月至3年),隨訪率52.7%。 結(jié)論：1.腎結(jié)核發(fā)病年齡仍集中在20-40歲；2.典型病例逐漸減少；3.尿找抗酸桿菌的特異性高,但陽(yáng)性率低；4.B超、CT是診斷腎結(jié)核的主要輔助檢查；5.腔鏡下結(jié)核腎切除術(shù)具有創(chuàng)傷小、出血少、術(shù)后康復(fù)快等優(yōu)勢(shì)；6.泌尿、生殖系結(jié)核抗結(jié)核治療6個(gè)月以上為宜。
[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.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R527.1

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