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摘要: 目的:探讨输尿管镜在早期泌尿系结核诊断和治疗的应用价值。方法:回顾性分析21例应用输尿管镜诊断和治疗早期泌尿系结核患者的临床资料。21例输尿管镜表现分别为输尿管狭窄14例、输尿管开口炎性水肿4例、输尿管下段息肉3例。18例通过输尿管镜收集肾盂尿作结核杆菌聚合酶链反应(MTb-PCR)、沉渣找抗酸杆菌(AFB)检查和结核杆菌培养诊断为泌尿系结核,其中16例(88.9%)尿MTb-PCR呈阳性,11例(61.1%)尿沉渣找AFB阳性,7例(38.9%)结核杆菌培养阳性。3例输尿管下段息肉,用输尿管镜摘除息肉作病理检查,2例病理诊断为输尿管结核,1例误诊为输尿管炎性息肉。11例输尿管下段狭窄予行输尿管镜狭窄内切开术,其余10例予行输尿管镜扩张置管术。除误诊为输尿管炎性息肉的1例患者外,20例术后均予抗结核治疗至少6个月。结果:21例平均随访18个月,12例(57.1%)一次手术治愈;8例出现狭窄复发,5例需再次行输尿管镜狭窄内切开术治愈,3例因狭窄多次复发致无功能肾行患肾切除术;误诊为输尿管炎性息肉1例,术后12个月复查发现患侧结核性脓肾及膀胱挛缩,予行患肾切除+乙状结肠膀胱扩大术。结论:早期泌尿系结核可表现为输尿管狭窄、输尿管开口炎性水肿或输尿管下段息肉。输尿管镜技术有助于早期诊断和治疗泌尿系结核。Abstract: Objective:To evaluate the significance of ureteroscopy(URS) in the diagnosis and treatment of early urinary tuberculosis. Method:A retrospective review was done in 21 cases (12 males and 9 femals,mean age of 32 years)of early urinary tuberculosis diagnosed and treated by ureteroscopy. The presentations under ureteroscopy were ureteral stenosis in 14 cases, inflammatory edema of ureteral orifice in 4 cases and distal ureteral polyps in 3 cases. Eighteen cases were diagnosed with urinary tuberculosis through collecting pelvis urine for Mycobacterium tuberculosis (MTb) examination under ureterscopy. Of those 18 cases, Polymerase chain reaction (PCR) for MTb in pelvis urine was positive in 16 cases (88.9%). Acid fast bacilli (AFB) smears was positive in 11 cases(61.1%). MTb culture was positive in 7 cases(38.9%). Of 3 patients in whom ureteral polyps biopsy was taken through ureteroscopy,2 patients were diagnosed with ureteral tuberculosis, another one was misdiagnosed with ureteral inflammatory polyps.11 cases of ureteral stenosis were treated by endoureterotomy. The remaining 10 cases were treaed by dilation on ureteroscopy under direct vision. Except for one case misdiagnosed with ureteral inflammatory polyps, anti-tuberculosis therapy had been applied in 20 patients after surgery at least for 6 months.Result:Twenty-one cases have been followed up for an average of 18 months.12 cases(57.1%)were cured after a single session of endoureterotomy or dilation. Five cases due to recurrent ureteral stenosis needed repeated endoureterotomy. Nephrectomy was finally performed in 3 cases due to non-salvageable kidneys resulted from recurrent ureteral stenosis. Another case misdiagnosed as ureteral inflammatory polyps was treated by nephrectomy and augmentation cystoplasty at 12 months after dilation. Conclusion:Ureteral stenosis, inflammatory edema of ureteral orifice or distal ureteral polyps are the common presentations of early urinary tuberculosis.It is safe and effective to diagnose and treat early urinary tuberculosis through ureteroscopy.
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Key words:
- urinary tuberculosis /
- urinary obstruction /
- endoscopy
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[1] 梁国标,沈寅初,罗旭,等.肾结核诊治分析(附52例报告)[J].中华泌尿外科杂志,2004,25:15-17.
[2] SINHA M,CHACKO K N,KEKRE N S,et al.Tu-bercular ureteric strictures[J].J Pak Med Assoc,2005,55:414-416.
[3] HEMAL A K,GUPTA N P,RAJEEV T P,et al.Polymerase chain reaction in clinically suspected geni-tourinary tuberculosis:comparison with intravenousurography,bladder biopsy,and urine acid fast bacilliculture[J].Urology,2000,56:570-574.
[4] 夏术阶,荆翌峰.关注泌尿系结核[J].临床泌尿外科杂志,2005,20:385-386.
[5] 夏术阶,荆翌峰,孙晓文,等.输尿管镜在不典型泌尿系结核诊断中的应用(附6例报告)[J].现代泌尿外科杂志,2005,10:152-153.
[6] 郑付平,尚庆亚,杨建华,等.结核性输尿管狭窄4例[J].临床泌尿外科杂志,2000,15:229-230.
[7] PUNEKAR S V,RAO S R,SWAMI G,et al.Bal-loon dilatation of ureteric strictures[J].J Postgradu-ate Medicine,2000,41:23-25.
[8] 刘永达,袁坚,李逊,等.腔内泌尿外科技术治疗输尿管狭窄[J].中华泌尿外科杂志,2006,27:608-611.
[9] HEMAL A K,GUPTA N P,KUMAR R.Compari-son of retroperitoneoscopic nephrectomy with opensurgery for tuberculous nonfunctioning kidneys[J].JUrol,2000,164:32-35.
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