摘要
目的分析一侧肾结核对侧肾积水的诊断方法以及治疗的远期效果。方法回顾性分析我院收治的104例一侧肾结核对侧肾积水患者的临床资料,对其诊断结果、治疗方法及随访结果进行分析。结果 38例在就诊时已出现慢性肾衰竭,42例是在结核肾切除后3～15个月发生慢性肾衰竭,其余24例在结核侧肾脏切除术后对侧肾积水有不同程度改善。60例在结核肾切除前或后行积水侧肾造瘘;7例长期留置肾造瘘管,拒绝再次手术治疗,输尿管膀胱再植术24例,肠管扩大膀胱术47例,膀胱再生2例,积水侧未行手术干预24例。随访6个月～28年,除肠管膀胱扩大术2例失访外,其余102例获得随访,其中7例长期留置肾造瘘管的患者中有5例在术后1～14年死于尿路感染,2例分别在术后5年和8年时死于心脑血管疾病。膀胱再生2例中1例2年后死于尿路感染,另1例21年发生肾衰竭,肾积水明显,经皮肾造瘘术后2年死于肾盂肾炎。其余经再次手术治疗69例和自然恢复24例中死于心脑血管疾病5例,共88例患者存活良好,血尿素氮和肌酐基本正常,并能参加一般工作和体力劳动。结论一侧肾结核对侧肾积水的患者需要根据不同的积水原因采取恰当手术治疗,远期效果良好。
Objective To analyze the diagnosis of renal tuberculosis with contralateral hydronephrosis and its long - term efficacy of treatment. Methods Clinical data of 104 cases of renal tuberculosis with contralateral hydronephrosis admitted to our hospital were retrospectively analyzed. The diagnosis results, treating method and prognosis were analyzed. Results 38 cases already had chronic renal failure on diagnosis, 42 cases had chronic renal failure 3 to 15 months after the resection of tuber- culosis kidney and the other 24 cases showed improvement on contralateral hydronephrosis after the resection of tuberculosis kid- ney. 60 cases were given nephrostomy in the hydronephrosis side before and after the resection of tuberculosis kidney. 7 cases had permanent nephrostomy tube and denied second - time surgery treatment. 24 cases had ureteral reimplantation, 47 cases had intestinal canal and bladder expansion. 2 cases had bladder regeneration. 24 cases were not given intervention in the hydrone- phrosis side. All the patients were followed up for 6 to 28 months. Two cases having intestinal canal and bladder expansion were lost to follow - up and other 102 cases were successfully followed up. Of the 7 cases who had permanent nephrostomy, 5 cases died of urinary tract infection one to 14 years after operation and 2 cases died of cardiovascular and cerebrovascular diseases 5 years and 8 years after operation respectively. Of the two cases who had bladder regeneration, one case died of urinary tract in- fection two years later, and the other case had renal failure 21 years later with obvious hydronephrosis and was died of pyelone- phritis two years after percutanous nephrostomy. 69 cases were treated by second - time operation, 24 cases spontaneous recovery and a total of 88 cases survived well with normal blood urea nitrogen and creatinine and can participate in ordinary work and physi- cal work. Conclusion Appropriate surgical treatment on the basis of different causes can achieve long - term efficacy on patients with unilateral renal tuberculosis and contralateral hydronephrosis.
出处
《中国全科医学》
CAS
CSCD
北大核心
2012年第27期3168-3170,共3页
Chinese General Practice
关键词
结核
肾
肾积水
诊断
治疗
Tuberculosis, renal
Hydronephrosis
Diagnosis
Therapy
