泌尿、男生殖系結(jié)核(文件)
【正文】 if cultures is positive). ? Gow (1979) finds that a 6month course of drugs is adequate. ? Isoniazid, rifampin, pyrazinamide and vitamin C daily for 2 months. ? Followed by isoniazid, rifampin and vitamin C for 4 months. ? The urine must be studied bacteriologically every 6 months during treatment and then every year for 10 year. Treatment 手術(shù)治疔 1. 腎切除 :無功能腎結(jié)核；腎實(shí)質(zhì)破壞 2/3個(gè)大盞以上 ，合并有難以控制的高血壓；伴輸尿管嚴(yán)重梗阻 。 Pathology ? 膀胱結(jié)核 : ? 同側(cè)輸尿管開口 —粘膜充血、水腫等改變 —形成結(jié)核結(jié)節(jié) —膀胱攣縮 —纖維組織增生 對側(cè)輸尿管口狹窄，閉合不全 —引起梗阻積水并感染健腎。 ? 極少數(shù)情況下，腎實(shí)質(zhì)大部或全部被膿腫取代， 形成結(jié)核型膿腎或腎積膿。 Pathology ? 腎積膿 : ? 結(jié)核菌到達(dá)腎髓質(zhì)后大量繁殖，破壞腎實(shí)質(zhì)。 ? 80%累及雙腎，但大多數(shù)能自行愈合，形成斑痕或鈣化。 ? 約占全部肺外結(jié)合的 14% ? 與經(jīng)濟(jì)落后、醫(yī)療水平底有關(guān) ? 好發(fā)年齡 20~40歲青壯年 ? 男性大于女性， 2： 1左右 概 述 ? 原發(fā)性結(jié)核病 : 首次感染結(jié)核菌 , 引起的結(jié)核病 肺結(jié)核 ? 繼發(fā)性結(jié)核病 : 有結(jié)核菌感染后 , 已建立細(xì)胞免疫和變態(tài)反應(yīng)后發(fā)生的結(jié)核病 . ? 發(fā)病機(jī)理 ? 人體首次感染結(jié)核菌 —機(jī) 體無免疫力 —巨 噬細(xì)胞不能殺死結(jié)核菌 —結(jié) 核菌蔓延 —經(jīng) 淋巴或血液播散到全身 —在 各組織中著床 —潛 伏灶 —一 般情況下不發(fā)病 —機(jī) 體免疫力地下時(shí)或營養(yǎng)不良時(shí) —潛 伏菌大量繁殖 —發(fā) 病 概 述 ? 感染途徑： 4種 1. 血性感染：最常見 2. 接觸感染：通過性生活或污染物傳播，少見 3. 淋巴感染：罕見 4. 直接蔓延：罕見 泌尿、男生殖系統(tǒng)內(nèi)部傳播： 1. 順行蔓延：腎 —輸 尿管 —膀 胱 2. 逆行蔓延：膀胱 —健 側(cè)輸尿管 —健 側(cè)腎臟 血行傳播 順行傳播 逆行傳播 Etiology ? The kidney and possibly the prostate are the primary sites of tuberculous infection in the genitourinary tract. ? All other genitourinary ans bee involved by either ascent ( prostate to bladder ) or descent ( kidney to bladder, prostate to epididymis). ? The testis may bee involved by direct extension from epididymal infection. Pathogenesis A. kidney and ureter: ? A shower of TB hits the renal cortex, the anisms may be destroyed by normal tissue resistance. ? Only scars are found in the kidney. ? However, if enough bacteria of sufficient virulence bee lodged in the kidney and are not overe, a clinical infection is established. Pathogenesis A. kidney and ureter: ? Tuberculosis of the kidney progresses slowly。 it may take 15~20 years to destroy a kidney in a patient who has good resistance to the infection. ? Therefore, there is no renal pain and little or no clinical disturbance of any type until the lesion has involved the calyces or the pelvis. ?
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