【摘要】 目的:提高对非典型肾结核临床特点的认知及诊治水平。方法:回顾性分析1979年1月～2009年12月收治的45例非典型肾结核患者的临床资料:男24例,女21例,年龄19～61岁,平均38岁,其中20～50岁者38例,占84.4%。临床表现为尿频31例(68.9%),肉眼或镜下血尿9例(20.0%),尿常规不正常36例(80.0%)。15例(62.5%)男性患者曾诊为慢性前列腺炎,治疗1～3年无效,后诊为肾结核;7例伴有附睾结核,其中3例已在外院行附睾切除术。治疗前行尿路造影、CT和B超检查。9例采用异烟肼加利福平加乙胺丁醇药物治疗,疗程9～12个月;36例于抗结核治疗2、3周后行患肾切除术,4例加行附睾切除。结果:尿路造影、CT和B超诊断准确性分别为21.2%、100%和88.9%。36例手术治疗者全部治愈,9例药物治疗者中,5例在6～24个月复查时,患肾损坏严重,遂行肾切除。结论:非典型肾结核的膀胱刺激症状不明显,尿常规、B超、静脉肾盂造影是主要的检查方法,CT具有较大的诊断价值;外科手术仍是肾结核无功能肾的主要治疗手段。更多还原

【Abstract】 Objective:To improve the diagnosis and treatment of atypical renal tuberculosis.Methods:From January 1979 to Decmeber 2009,45 cases with atypical advanced renal tuberculosis were reviewed retrospectively. All the cases about age clinical manifestations,imaging and treatments were discussed.Results:There were 45 cases of atypical renal tuberculosis including 24 men and 21 women,with the average age of 38(from 19 to 61).38 cases(84.4%) of the ages was located in the range of 20-50 years old.33 cases(73.3%) were from rural areas. The course of this disease was from 3 months to 8 years(mean 28.6 months).The clinical manifestations of most cases included urinary frequency of 31 cases(68.9%),gross and microscopic hematuria 9 cases(20.0%).unusual urine routine 36 cases(80.0%).15 of 24 patients of the man were treatment for chronic prostatitis for 1 to 3 yeas and the patients was final diagnosis of renal tuberculosis.7 patients of the man were tuberculosis of epididymis and three underwent epididymectomy in other hospitals.The diagnostic accuracy of urography,CT and B-type ultrasonography were 21.2%,100%and 88.9%respectively.Conclusions:Atypical renal tuberculosis was no typical irritation sign of bladder.The main diagnostic methods are routine uronoscopy,B-type ultrasonography and intravenous pyelography.CT is the most valuable diagnostic method for atypical renal tuberculosis.Surgery operation for non-functioning kidney is still mainly therapeutic methods.更多还原