Novikov B I, Skornyakov S N, Berdnikov R B, Savelev A V
Ural Research Institute of Phthisiopulmonology of Minzdrav of Russia, Ekaterinburg.
Urologiia. 2016 Dec(6):47-53.
To Study clinical and morphological variants of kidney tuberculosis (KTB), for grounding a tactics of surgical treatment.
There were 107 examined patients (patients with cavitary lesions of kidneys: cavernous and multi-cavernous), operated in different phases of KTB. There were 56 men (52,3%) and women - 51(47,7%). The mean age of patients was 57,6 years (23-84 years). All the patients had a complex examination, including X-ray and ultrasound investigations, computer tomography ( was performed selectively), bacteriological examinations of urine and morphological examinations of removed kidneys or their parts.
Surgical interventions were as follows: open surgery nephrectomy 86/107 (80,4%), open organ-sparing surgery (resections of kidneys) 21/107 ( 19,6%). Mycobacterium tuberculosis were revealed by cultural method in 68,6% of cases in patients with cavernous KTB and in 76,3% of cases in patients with multi-cavernous KTB. In appliance with pathomorphological results of presented specimens, there were revealed 3 groups, each one with its own properties of cavern wall. I group (74 specimens) - stage of active progressing KTB, II group (20 specimens) - stage of intermediate activity, III group (13 specimens) - stage of healed caverns. Performed morphological investigations allowed us grounded a rational tactics of surgical treatment. It was defined that the longer specific anti-TB therapy was carried out the less frequency of TB progression we would have. However when it presented isolated cavitary lesion (isolated cavern), the performance of adequate and long courses of chemotherapy is not worth to do. Only surgical interventions (resection of infected tissue) with the anti-TB therapy allowed to reach the satisfactory results in treatment of KTB.
研究肾结核（KTB）的临床和形态学变异，为制定手术治疗策略提供依据。
对107例接受检查的患者（肾空洞性病变患者：海绵状和多海绵状）进行了研究，这些患者处于肾结核的不同阶段。其中男性56例（52.3%），女性51例（47.7%）。患者的平均年龄为57.6岁（23 - 84岁）。所有患者均接受了综合检查，包括X线和超声检查、选择性计算机断层扫描、尿液细菌学检查以及切除肾脏或其部分的形态学检查。
手术干预方式如下：开放性肾切除术86/107（80.4%），开放性保留器官手术（肾部分切除术）21/107（19.6%）。采用培养法在海绵状肾结核患者中68.6%的病例及多海绵状肾结核患者中76.3%的病例中发现结核分枝杆菌。根据所呈现标本的病理形态学结果，分为3组，每组空洞壁具有各自的特性。I组（74个标本）——肾结核活动进展期，II组（20个标本）——中间活动期，III组（13个标本）——愈合空洞期。所进行的形态学研究使我们能够制定合理的手术治疗策略。已确定进行特异性抗结核治疗的时间越长，结核进展的频率就越低。然而，当出现孤立性空洞病变（孤立性空洞）时，进行充分且长期的化疗并不值得。只有手术干预（切除感染组织）联合抗结核治疗才能在肾结核治疗中取得满意效果。
