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目的:探讨肾结石并发肾结核的诊断、治疗方法。方法:回顾性分析肾结石并发肾结核8例患者的临床资料。结果:男性5例,女性3例,平均46岁。6例有患侧腰部疼痛及扣击痛,经尿常规、尿查抗酸杆菌、B超、CT检查等,临床诊断肾结石伴患肾无功能4例,肾结石2例,肾结石伴肾结核2例,其中2例尿液结核杆菌检测阳性而确诊,临床诊断准确率为25%。4例接受患肾切除,1例为肾盂切开取石,1例接受体外冲击波碎石(ESWL)后高热行肾切除治疗。2例患者肾功能衰竭并发多器官功能衰竭死亡。术后病理确诊肾结石并发肾结核5例,确诊后均予抗结核药物治疗,随访6～36月均未见复发。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,患者大多肾功能损害严重而患肾大小变化不不著,尿常规及查抗酸杆菌和静脉尿路造影(IVU),CT等影像学检查对确立诊断具有重要价值,抗结核同时治疗结石是其治疗的核心,提高对肾结核的认识有助于提高治疗效果。
Objective: To investigate the diagnosis and treatment of renal stones complicated with renal tuberculosis. Methods: The clinical data of 8 patients with nephrolithiasis and renal tuberculosis were analyzed retrospectively. Results: There were 5 males and 3 females, with an average of 46 years. 6 cases of ipsilateral lumbar pain and claw pain, urinary routine examination, urine acid-fast bacilli, B ultrasound, CT examination, clinical diagnosis of kidney stones with renal nonfunction in 4 cases, 2 cases of kidney stones, kidney stones with kidney Tuberculosis in 2 cases, of which 2 cases of urine test positive for M. tuberculosis confirmed, the clinical diagnosis accuracy rate was 25%. 4 underwent nephrectomy, 1 underwent pyelolithotomy, and 1 received high-heat nephrectomy after ESWL. Two patients died of multiple renal failure with renal failure. Postoperative pathological diagnosis of kidney stones in 5 cases of renal tuberculosis, were diagnosed with anti-TB drug treatment, follow-up 6 to 36 months were no recurrence. Conclusions: The clinical manifestations of renal tuberculosis complicated with renal tuberculosis are not typical. The symptoms of renal tuberculosis are mostly covered by the symptoms of kidney stones. Most of the patients suffer severe renal damage with varying size of the kidney. Urinary routine examination and acid-fast bacilli and intravenous urography IVU), CT and other imaging studies to establish the diagnosis of great value, anti-TB treatment of stones is the core of its treatment, improve understanding of renal tuberculosis will help to improve the treatment effect.