泌尿、男生殖系結(jié)核-展示頁
2025-06-04 12:13本頁面
【正文】 . 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。 ? 結(jié)核結(jié)節(jié) : 類上皮細(xì)胞、多核巨細(xì)胞、淋巴細(xì)胞、漿細(xì)胞、成纖維細(xì)胞等組成。 ? 80%累及雙腎，但大多數(shù)能自行愈合，形成斑痕或鈣化。 ? 從病理型腎結(jié)核 —臨 床型腎結(jié)核 ? 病史長，一般 5 年 ? 90%為單側(cè)。 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)。 ? 膿腫向伸盞破潰，進(jìn)入腎盂、輸尿管、膀胱 —導(dǎo)致繼發(fā)性結(jié)核。 ? 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。 ? 病變由粘膜向全層侵犯 —導(dǎo)致輸尿管壁增厚、變硬、輸尿管縮短、狹窄、收縮功能下降。 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。 ? 前列腺結(jié)核和附睪結(jié)核 : ? 少見。 ? 機(jī)體低抗力低時：以破壞為主 —潰 瘍和膿腫 ? 機(jī)體低抗力高時：以修復(fù)反應(yīng)為主 —纖 維化和鈣化 Pathology 病理型腎結(jié)核 臨床型腎結(jié)核 腎積膿 輸尿管結(jié)核 腎自截 膀胱結(jié)核 前列腺結(jié)核 附睪結(jié)核 Clinical findings ? Tuberculosis of the genitourinary tract should be considered in the presence of any of the following situations: 1. Chronic systitis that refuses to respond to therapy. 2. The finding of without bacteria in culture of the urinary sediment. 3. Gross or micorscopic hematuria. 4. Enlarged epididymis with a beaded or thickened 5. A chronic draining scrotal sinus 6. Induration or nodulation of the prostate and thickening of one or both seminal vesicles. Clinical findings ? The diagnosis rests on the demonstration of tubercle bacilli in the urine by culture. ? The extent of the infection is determined by: 1. The palpable findings in the epididymises, prostate and seminal vesicles 2. The renal and ureteral lesions as revealed by IVP 3. involvem
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