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肾结石并发肾结核的诊断 附6例报告 |
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姜睿 欧阳芳 吴虹 李洪位
摘 要：目的：探讨肾结石并发肾结核的诊断方法。方法：回顾性分析6例此病患者临床资料。结果：临床诊断正确者1例，术后病理确诊者4例，1例因接受ESWL后尿液结核杆菌培养阳性而确立诊断，临床诊断准确率为16.7%。结论：肾结石并发肾结核临床表现不典型，肾结核症状多被肾结石症状掩盖，故应注意临床资料中有提示意义的线索，对肾结石伴肾功能严重损害而患肾大小变化不著者尤应警惕并发肾结核。
关键词：结核，肾 肾结石 诊断
Diagnosis of renal calculi associated with renal
tuberculosis (Report of 6 cases)
JIANG Rui LI Hong-wei
(Department of Urology, Affiliated Hospital, Luzhou Medical College,Luzhou, Sichuan,646000）
OUYANG Fang
（Department of Medicine,Affiliated Hospital,Luzhou Medical College)
WU Hong
（Yibin Chueipin Health School)
Abstract：Purpose： To improve the diagnostic technique for renal calculi associated with renal tuberculosis. Methods： 6 cases of renal calculi associated with renal tuberculosis were analysed retrospectively. Results： The clinical manifestations, laboratory examinations and imaging characteristics were presented. Flank dull ache flank, irritative symptoms and gross hematuria were the most common symptoms encountered in these patients. The diagnosis of renal tuberculosis were easily neglected in such patients. The clinical diagnosis accuracy was 16.7%(1/6). Conclusions： The diagnosis of renal calculi associated with tuberculosis found on acidfast stains on urinary sediment, TB-PCR and imagings should be made on careful analysis. Renal calculi associated with renal tuberculosis should be paid atlention to the no enlargement and nonfunction kidney with calculi.
Key words：Tuberculosis,renal Kidney calculi Diagnosis▲
肾结石并发肾结核较少见，且肾结核的临床表现常被肾结石掩盖，极易漏诊。1993年1月至1999年1月我们诊治此类患者6例，现报告如下。
1 临床资料
本组6例，男5例，女1例。年龄40～66岁，平均52.4岁。病程1个月～10年。右侧4例，左侧2例。6例均有患侧腰背疼痛及叩击痛，4例有严重肉眼血尿，5例伴尿急、尿频、尿痛症状。腰腹部均未扪及包块，1例扪及双侧附睾变硬，输精管增粗，呈串珠状改变。3例血沉＞20 mm/h。6例尿常规检查均有不同程度的红细胞(++～++++)、白细胞(++～++++)、脓细胞(+++～++++)，4例尿pH值呈酸性。1例尿中查见大量抗酸杆菌。X线胸片、心电图均未发现异常。
B超检查：诊断肾结石6例，其中4例为多发结石，2例为铸形结石，结石大小为(2.5 cm×2.0 cm)～(4.0 cm×3.5[1] [2] 下一页
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