超声论文：肾结核的超声分型对临床治疗的指导意义

1、超声论文：肾结核的超声分型对临床治疗的指导意义【中文摘要】与肾结核是泌尿生殖系统常见的特异性感染性疾病, 常导致其它泌尿生殖系统结核。近几年我国肾结核发病率有上升趋势, 其发病特点是在肺结核发生时或者治愈多年后才出现的肾结核的临 床症状，症状多无特异性，因此临床诊断较为困难。超声检查因其简便 易行、廉价、无创伤的优势，被广泛地用于肾结核的诊断，为肾结核的 诊断提供了一种直观的影像学诊断依据。肾结核存在不同病理发展阶 段的变化，决定了肾结核超声图像的多样性，声像图表现复杂,多无特 异性，误诊率较高。随着超声仪器分辨率的不断提高，超声医师对肾结 核的超声影像学征象进行了大量的研究，诸如检查方法的研

2、究、肾结 核超声征象的研究、超声诊断符合率的研究、超声与其他影像学检查 方法的对比研究等，超声已逐渐作为一种简便的方法，为肾结核的诊 断提供可靠的信息。本研究的是探讨肾结核的超声分型对临床治疗的 指导价值，为临床制定治疗方案提供较为可靠的依据。资料与方法1. 临床资料凹顾性分析我院收治的106例肾结核确诊患者（共126个肾 脏）的临床资料,每一患者逐项记录入院时的症状、体征、实验室检查 的阳性表现和超声征象。临床表现：尿频、尿急、尿痛63例，腰痛 41例,血尿29例，小便石灰水样1例。既往患肺结核39例,椎体结核 17例,膀胱结核7例，附睾结核3例,结核性脑膜炎3例,左膝关节结 核1例,肝结核

3、1例。106例肾结核患者中,42例经手术证实,64例经 抗结核药物治疗有效而确诊为肾结核，其24h尿沉渣涂片抗酸染色杆 菌检查为阳性或结核杆菌培养阳性或尿pcr结果阳性。106例肾结核 患者均曾行超声检查，其中87例曾行ct检查,49例曾行静脉肾盂造 影。2仪器与方法应用ge vivid7和ge vivid4超声诊断仪,探头频 率为3. 5mhz,凸阵探头。患者取平卧、仰侧卧或俯卧位，对双肾脏作 多切面、多角度扫查,测量肾的大小，观察肾脏的形态，肾脏包膜、肾 实质回声、病灶的大小、边缘、形态、回声，皮质与髓质的关系、肾 窦有无分离扩张以及输尿管声像图改变等。结果126个肾脏中，超声 正确诊断7

4、9个，准确率为62. 7% (79/126)；误诊38个，误诊率为30. 2%, 漏诊9个，漏诊率为7. 1%o漏诊的9个肾脏经ct和(或)静脉肾盂造 影检查显示肾内有异常密度，结合实验室检查和临床确诊为肾结核。 根据79例肾结核的超声图像特点,结合病理发展的进程，可归纳为以 下七类:结节型,5例，占6. 3%；囊肿型，15例，占19. 0%；积水型,23 例，占29. 1%；积脓型,9例，占11. 4%；萎缩型,11例,占13. 9%；钙化 型,6例，占7.6%；混合型，10例，占12. 7%o以上几种类型的cdfi均 显示段动脉血流分布稀疏,段动脉血流流速增快，阻力指数rt明显减 低，即呈

5、高速低阻型血流状态。在42例手术治疗的患者中，囊肿型5 例，占33. 3% (5/15)；积水型9例，占39. 1%(9/23)；积脓型7例，占 77.8%(7/9)；萎缩型10例，占90. 9%(10/11)；钙化型5例，占83. 3% (5/6)；混合型6例，占60. 0%(6/10)；其余64例均经抗结核药 物治疗。结论根据超声图像的特征对肾结核进行超声分型，为超声科 大夫诊断肾结核提供了重要依据，同时为临床的诊断、鉴别诊断和治 疗提供了重要、町靠的信息。研究表明：大多数结节型、囊肿型和积 水型肾结核患者只需要抗结核药物治疗；而大部分积脓型和混合型肾 结核患者多需行手术治疗；几乎所有的萎

6、缩型和钙化型肾结核患者需 行肾切除术。【英文摘要】background and objectiverenal tuberculosis, that often 1eads to other urogenital system tuberculosis, is the common specificity infectious diseases in the urogenital system in recent years, the incidence of renal tuberculosis in china has a tendency to rise the clinical symp

7、toms of renal tuberculosis usually are found when tuberculosis has existed or when tuberculosis has been cured after years the clinical symptoms of renal tuberculosis have no specificity, so it is difficult to make the clinical diagnosis ultrasound examination has been widely used for its convenienc

8、e, low price and non-invasive quality and provides the visual imaging for the diagnosis of renal tuberculosis as a diagnostic basis renal tuberculosis has different pathological development phases, so ultrasonic images of renal tuberculosis are varied and complex nonspecific performance of ultrasoni

9、c images leads to higher misdiagnosis rate with continuous improvement of the ultrasonic instruments resolution, ultrasound doctors have done a lot of researches on the ultrasonic imaging features of renal tuberculosis, such as method of examination, ultrasound signs, ultrasonic diagnosis accuracy a

10、nd comparative study with other imaging examination methods ultrasotmd provides reliable information as a kind of simple method for the diagnosis of renal tuberculosis the purpose of this study is to explore the guiding value of ultrasonic typing of the renal tuberculosis on the clinical treatment a

11、nd provide a reliable basis for clinical treatment scheme materials and methodsl patientsthe clinical data of 106 patients with renal tuberculosis (totally 126 kidneys) were retrospectively reviewed. the symptoms, signs, laboratory examination of positive performance and sonographic signs of each ad

12、mission patient was recorded item by item clinical manifestations:frequent micturition, urgent urinaiction, odynuria 63 cases, lumbago 41 cases, hematuria 29 cases and urinate 1ime water 1 case always with tuberculosis 39 cases, vertebral tuberculosis 17 cases, bladder tuberculosis 7 cases, epididym

13、al tuberculosis 3 cases, tuberculous meningitis 3 cases, left knee joint tuberculosis 1 case and liver tuberculosis 1 case in the 106 renal tuberculosis patients, 42 patients were confirmed by surgery,64 cases were diagnosed as renal tuberculosis by anti-tuberculosis medication effective, its 24h ur

14、ine dreg smear an acid fast stain coli inspection for positive or tubercle bacillus culture is positive or urine pcr result is positive 106 renal tuberculosis patients all did ultrasonic examination, 87 cases had done ct examination, 49 cases had done intravenous pyelogram. 2. methodsthe ultrasound

15、examinations were performed using standard equipment (ge vivid7 and ge vivid4) the probe frequencies used with both apparatuses were the same 3. 5 mhz the patients were observed via multiple cross sections in routine supine, prone and lateral positions the size of the kidney was measured. the shape

16、of the kidney, the intensity and homogeneous degree of the echoes reflected from the renal cortex and medulla were observed. any abnormal echo, separation or distension of the renal sinus, calyx, pelvis, ureter, and so on, were also made note of. resultsln the 126 kidneys,79 kidneys were diagnosed b

17、y ultrasound, accuracy rate was 62. 7%(79/126) ; 38 kidneys were misdiagnosed, the misdiagnosis rate was 30. 2%, 9 kidneys were missed diagnosis, missed diagnosis rate was 7. 1%. 9 missed diagnosed kidneys showed abnormal density by ct and (or) intravenous pyelogram examination, and diagnosed as ren

18、al tuberculosis combining with laboratory examination and the clinic combined with pathological progress, the ultrasonic images of 79 renal tuberculosis patients can be classified into the following seven categories:nodule type, 5 cases, accounting for 6. 3%; cyst type,15 cases, accounting for 19.0%

19、; hydrops type, 23 cases, accounting for 29. 1%; empyema type,9 cases, accounting for 11.4%; atrophy type,11 cases, accounting for 13. 9%; calcification type, 6 cases, accounting for 7. 6%; mixed type, 10 cases, accounting for 12. 7%. the cdf i of above several types all showed that section art eria

20、l f 1 ow distribution was sparse, f 1 ow rate increased, and resistance index(ri) decreased significantly, so the blood flow state was high-speed low resistance type in 42 cases patients of surgical treatment, cyst type 5 cases, accounting for 33. 3%(5/15); hydrops type 9 cases, accounting for 39.1%

21、(9/23);empyema type 7 cases, accounting for 77.8%(7/9):atrophy type 10 cases, accounting for 90. 9%(10/ll); calcification type 5 cases, accounting for 83. 3%(5/6) ; mixed type 6 cases, accounting for 60. 0%(6/10) ; the remaining 64 cases were both treated by anti-tuberculosis medicationconclusionultrasonic typing of renal tuberculosis provided an important basis on diagnosing renal tuberculosis and an important and reliable information for clinical diagnosis, diff