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1、 超声论文：肾结核的超声分型对临床治疗的指导意义超声论文：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
2、行了大量的研究,诸如检查方法的研究、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.临床资料回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
3、核 3 例,结核性脑膜炎 3 例,左膝关节结核 1 例,肝结核 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
4、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 79 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%。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
5、12.7%。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 RI 明显减低,即呈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、可靠的信息。研究表
6、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 leads to other urogenital system tuberculosis, is the common specificity infectious diseases in the urogenital system. In recent years, the incidence of renal
7、tuberculosis in China has a tendency to rise. The clinical symptoms 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 diagnosi
8、s. Ultrasound examination has been widely used for its convenience, 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 tubercu
9、losis are varied and complex. Nonspecific performance of ultrasonic 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 metho
10、d of examination, ultrasound signs, ultrasonic diagnosis accuracy and comparative study with other imaging examination methods. Ultrasound 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 ul
11、trasonic typing of the renal tuberculosis on the clinical treatment and provide a reliable basis for clinical treatment scheme. Materials and methods1. PatientsThe clinical data of 106 patients with renal tuberculosis (totally 126 kidneys) were retrospectively reviewed. The symptoms, signs, laborato
12、ry examination of positive performance and sonographic signs of each admission patient was recorded item by item. Clinical manifestations:frequent micturition, urgent urinaiction, odynuria 63 cases, lumbago 41 cases, hematuria 29 cases and urinate lime water 1 case. Always with tuberculosis 39 cases
13、, vertebral tuberculosis 17 cases, bladder tuberculosis 7 cases, epididymal 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 a
14、s renal tuberculosis by anti-tuberculosis medication effective, its 24h urine 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 examin
15、ation,49 cases had done intravenous pyelogram.2. MethodsThe ultrasound 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, pro
16、ne and lateral positions. The size of the kidney was measured. The shape 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.ResultsIn the 126 kidneys,79 kidneys were diagnosed by ultrasound, accuracy rate was 62.7%(79/126); 38 kidneys were misdi
