泌尿、男生殖系結(jié)核-閱讀頁(yè)
2025-06-10 12:13本頁(yè)面
【正文】 the ulcerated calyces. obliteration of one or more calyces. dilatation of the calyces due to ureteral stenosis from fibrosis. abscess cavities that connect with calyces. single or multiple ureteral strictures. absence of function of the kidney due to plete ureteral occlusion and renal destruction (Autonephrectomy) IVP IVP 右腎不顯影 Clinical findings B. Signs: 7. CT: 8. Ultrasound: 9. Cystoscope: typical tubercles or ulcers of tuberculosis. Biopsy can be done if necessary. “golfhole” (gaping) ureteral orifice. Differential diagnosis 1. Chronic nonspecific cystitis or pyelonephritis 2. Acute or chronic nonspecific epididymitis 3. Multiple small renal stones 4. Tumor Treatment ? The following drugs are usually considered as the firstline drugs “*”: ? *Isoniazid: 300mg/d ? *Rifampin : 450mg/d ? *Pyrazinamide: 1500mg/d ? Streptomycin: 1g/d, intramuscularly ? Ethambutol: 25mg/kg Treatment ? Most authorities advise appropriate medication for 2 years (or longer 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(wú)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?chē)?yán)重梗阻 。 3. 病灶清除術(shù) : 適合于結(jié)核膿腫 ， 一般穿刺解決 。 2. 若積水嚴(yán)重，腎功能不良則應(yīng)先解除 梗阻，然后切除無(wú)功能的結(jié)核腎臟。 ? 50~70%合并男生殖器結(jié)核 ? 附睪和前列腺結(jié)核常同時(shí)存在 Tuberculosis of epididymis ? 大多為單側(cè)，起病緩慢。 ? 附睪逐漸增大，多無(wú)明顯疼痛，腫大的附睪可與陰囊粘連或形成寒性膿腫、破潰成為竇道，經(jīng)久不愈。 ? 直腸指檢，前列腺有硬結(jié)。 2. 如治療效果不明顯或病變較大 ， 有膿腫形成 ， 則可行附睪切除 ， 術(shù)時(shí)應(yīng)盡量保留睪丸 。 Treatment ? In unilateral epididymal involvement, epididymectomy plus contralateral vasectomy is indicated to prevent descent of the infection from the prostate to that an ? bilateral epididymectomy should be done if both sides are involved． Tuberculosis of epididymis Tuberculosis of prostate ? 常無(wú)自覺(jué)癥狀。 ? 鑒別診斷： ? 前列腺炎 —普 通抗菌素有效 ? 前列腺癌 —老 年， DRE, PSA ? 治療： ? 采用藥物治療為主，一般不采用手術(shù)
規(guī)章制度相關(guān)推薦
鄂ICP備17016276號(hào)-1