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題 名 | Urinary Tract Tuberculosis: A 10-Year Experience=泌尿道之結核感染:十年經驗 |
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作 者 | 高士振; 方基存; 蔡啟仁; 陳國書; 黃秋錦; | 書刊名 | 長庚醫學 |
卷 期 | 19:1 1996.03[民85.03] |
頁 次 | 頁1-9 |
分類號 | 415.825 |
關鍵詞 | 泌尿道結核; Urinaty tract tuberculosis; |
語 文 | 英文(English) |
中文摘要 | 儘管抗結核藥快速地減少肺結核之發生率,但泌尿道結核並未隨著肺結核的下降而減少,在臨床上仍是慢性腎衰竭的重要原因之一,特別是在開發中國我們回顧了近十年來,在長庚醫院林口、基隆院區確定診斷之泌尿道結病共97例,包括男47例,女50例,平均年齡47歲(年齡範圍21到78歲),來探討其臨床表徵及預後。 除了2例診斷時合併有散播性結核病(military tuberculosis)及3例合併的性肺結核外,大多數患者仍以肺結核為其最常見之原發性病灶。臨床表現以非特異性之泌尿道感染症狀為主,只有9例合併發燒、體重減輕、食慾不振等全身症狀。在實驗室診斷方面,89%患者有異常之尿液常規檢查(血尿及/或膿尿);尿液結核菌培養之陽性率為73%;24%患者診斷時合併有細菌感染。35%患者診斷時已有腎功能不全,包括10例以急性腎衰辦作為起始之臨床表現,細菌感染及尿路阻塞為其最主要之惡化因素。8例合併生殖系統之結核,其中3例之常規尿液檢查及靜脈腎盂攝影均為正常,顯示早期行性及泌尿道傳播為其可能之致病機轉。放射線檢查方面,41%患者胸部X光有結核變化;94%患者之腎盂攝影為異常,其中大多數(74%)呈現晚期之變化,再加上診斷時有較高比例之貧血(27%)及腎功能不全(35%),顯示相當之患者診斷時腎組織 相當之缺損。由於腎臟鈣化之患者,仍有69%之尿液結核菌培養之陽性率,是否代表不活動性,這點值得進一步觀察。由於高抗藥性,在起始治療時至少三種抗核藥是需要的。泌尿道重建手術以解除輸尿管狹窄,保存腎功能是值得一試的。患者或接受抗結核藥或合併外科手術治療,除了6例須接受維持性血液透析治療外,大多數腎功能均能獲得穩定。 綜言之,泌尿道結核因其潛隱性進行,臨床表徵不具特異性。診斷惟賴高度懷疑,才能早期診斷及治療,方能避免腎功能之損害。 |
英文摘要 | Ninety-seven patients with urinary tract tuberculosis were reviewed from January 1983 at our hospital. Aside from two cases of military tuberculosis and three cases with coexisting active pulmonary tuberculosis, most urinary tract infections developed from a previous primary lung infection, developed from a previous primary lung infection. Patients usually exhibited local symptoms. Fever, weight loss and anorexia were uncommon. Eighty-nine percent of the patients had abnormal urinalysis (hermaturia and/or pyuria) Eight percent of the patients also had genital involvement, whereas 38% of these patients had normal intravenous pyelogram and urinalysis. Pyelograms disclosed abnormalities in 95% of the 97patients and most revealed late changes, which were correlated with higher incidence of azotemia and anemia noted at diagnosis. Chemotherapy is the mainstay of treatment and at least three antituberculous drugs are required for initial therapy due to high drug resistant rate. Reconstructive surgery is warranted to salvage renal function. Except 6 patients run into maintenance hemodialysis, the renal functions of all patients remained stable during the period of follow-up, either receiving chemotherapy alone or combined surgery. Renal calcification may not represent inactive process, which requires further evaluation. |
本系統中英文摘要資訊取自各篇刊載內容。