泌尿课件：泌尿及男性生殖系结核完整版

泌尿及男性生殖系结核TuberculosisoftheUrinaryandMaleGenitalSystemGENITOURINARYTUBERCULOSIS

Tuberculosishasbeenoneofthegreatimitatorsofalltime,andonlyafewyearsagowasthoughttobeadiseaseofthepast.Tuberculosis(TB)isadeadlyinfectiousdiseasewitharisingincidenceworldwide.Theurologist’sawarenessoftheclinicalfeaturesofgenitourinary(GU)TBisnecessarytoeffectivelytreatpatientswiththisdisease.Areviewoftheliteraturewillrevealthattheclinicalfeaturesandpathologyofgenitourinarytuberculosisdescribedintheearlierpartofthe20thcenturyhasremainedessentiallyvalidtodate.Currentresearchfocusesonepidemiologyofthenewresurgenceofthedisease,aswellasrapiddiagnosticmodalitiesandnewtreatmentregimenstocombatmultidrugresistantTB.TheGreatImitator是症状不特异，容易误诊的疾病。多为系统性疾病。

结核病有记载的历史，可以追溯到6000年前的意大利和埃及。法老王阿肯那顿,王后奈费尔提蒂

Akhenaton,aPharaohoftheeighteenthdynastyofEgypt,andhiswifeNefertitibotharebelievedtohavediedfromtuberculosis

SignsofthediseasehavealsobeenfoundinthespinesofEgyptianmummiesdatingbetween3000and2400

BCE

(Zinketal,2003).

我国1973年湖南长沙马王堆一号墓出土的2100年前的女尸肺上部及左肺门，发现有结核钙化灶，说明其生前可能是一个结核病患者。这是我国最早的可查证的结核病患者。《上海大众卫生报》2015-5-22Thebacilluscausingtuberculosis,Mycobacteriumtuberculosis,wasidentifiedanddescribedonMarch24,1882byRobertKoch.世界防治结核病日(WorldTuberculosisDay)在1982年纪念科赫氏发现结核菌100周年时，世界卫生组织(WHO)和国际防痨和肺病联合会(IUATLD)共同倡议将3月24日作为“世界防治结核病日”，以提醒公众加深对结核病的认识。流行病学资料GenitourinaryTB

Extrapulmonarysitesaccountfor10%oftuberculosiscases.GenitourinaryTBaccountsfor30%to40%ofallextrapulmonaryTB,secondonlytolymphonodalaffection(Eastwoodetal,2001).Indevelopedcountries,urogenitaltuberculosisoccursin2%to10%ofcasesofpulmonarytuberculosis,whileindevelopingcountriesitoccursinasmanyas15%to20%ofcases.2023/10/2812肾结核

TuberculosisofKidney2023/10/2813概述感染途径：血行感染、顺行播散、是全身结核的一部份病理性结核临床性结核肾自截膀胱挛缩Mostpersonscontroltheinitialinfectionanddevelopnoclinicalillness.Theyhavedormantbacilli,whichmaybegintoproducediseaseyearslaterafterdebilitatingdisease,trauma,corticosteroids,immunosuppressivetherapy,diabetes,orAIDS.2023/10/2815肾结核

诊断一、临床表现：

1.膀胱刺激症状

2.血尿

3.脓尿

4.肾区胀痛不适

5.全身症状

ClinicalManifestations

InthewordsofChang:“thekidneyisaninarticulateorgan;itsvocalcordsarethebladder”(Chang,1976).中医：肾与膀胱相表里2023/10/2817肾结核

诊断二、实验室检查：

1.尿常规：RBC、WBC2.尿浓缩查结核杆菌

3.结核菌培养或动物接种

Diagnosis1UrinalysisandCultureoldtuberculin，OTPurifiedProteinDerivative–TuberculinTest—MantouxTestNucleicAcidAmplification(NAA)Testing—PCRDiagnosis2RadiographyandEndoscopyPlainRadiographIntravenousUrography(IVU)ComputedTomographyandMRIUltrasonographyRetrogradePyelogramandAntegradePyelogramCystoscopyandUreteroscopy

结核的影像学表现在有效的抗结核药物被发明之前，结核病的主要治疗手段是营养、阳光加大气。

ThegreatestmilestoneinthetreatmentofTBwasthediscoveryoftheantituberculousdrugs,startingwithstreptomycinin1944,followedbypara-aminosalicylicacidin1946,isoniazid(INH)in1952,andrifampicinin1966.Thesediscoverieswerefollowedbytheintroductionofshortercoursesofchemotherapyforallformsoftuberculosis.2023/10/2824肾结核治疗一、一般处理：休息、营养、增强体质二、药物治疗：

1.应用抗结核药物适应症

2.用药原则：早期、联合、足量、足期、规律

3.常用抗结核药物：异烟肼、利福平、乙胺丁醇、链霉素、吡嗪酰胺等

2023/10/2825肾结核治疗

4.长程疗法：（18-24个月）异烟肼o.1一日三次利福平0.45一日一次乙胺丁醇0.25一日三次

短程疗法：

（6个月）2023/10/2828肾结核治疗三、手术治疗

1.全肾切除术

(1)适应症

(2)术前抗结核两周以上

(3)术后常规抗结核

2023/10/2829肾结核治疗三、手术治疗

2.部分肾切除术

(1)适应症

(2)术前抗结核3-6个月

(3)术后常规抗结核

2023/10/2830肾结核治疗三、手术治疗

3.肾结核晚期并发症的处理

(1)一侧肾结核对侧积水（吴氏理论）

(2)膀胱挛缩及UVJ狭窄

TreatmentMedicalTherapyAntituberculousDrugsSurgicalTherapyProcedurestoRelieveObstructionNephrectomyPartialNephrectomyUreteropelvicandUreteralSurgeryBladderSurgeryProstateandUrethra20世纪90年代后，WHO在全球推广直接面视下的督导化疗，使得结核病患者在6～8个月的治疗期间接受规范的治疗管理，进一步提高了结核病的治愈率。2023/10/2833附睾结核

TuberculosisofEpididymis

No.Cases%TuberculosisCasesbyPrimarySiteofDisease

Pulmonary107373.5Lymphatic15210.4Pleural694.7Miliary382.6Boneorjoint362.5Meningeal221.5Genitourinary171.2Peritoneal120.8Other412.8

Total1460100.0TuberculosisCasesbyAllSitesofDiseaseOnlypulmonarydisease99868.4Onlyextrapulmonary