肾结核的外科治疗需要新辅助化疗吗？

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泌尿生殖道结核的紧迫性及其社会意义仍然很高。随着抗结核药物的出现，进行器官保留手术成为可能，但是抗结核化疗，无论是在术前还是术后，都是极其重要的。临床观察表明，违反这一原则会导致严重并发症的发生。I.患者，40岁。诊断：“右肾多海绵体结核，左肾海绵体结核，第4期膀胱结核（微囊藻）”。她不规律地、随意地服用抗痨药。在这种背景下，在泌尿科的右侧进行腹腔镜肾切除术，在左侧进行穿刺肾造口术。抗结核药物治疗中断，导致肾功能衰竭的进展和肾盂肾炎的下一次发作。在这方面，她在Avicenna MC接受了再次手术：根据Studer的说法，腹腔镜下仅左侧肾脏的海绵体切开术、膀胱切除术、肠膀胱成形术。在术后期间，形成了水库-子宫瘘。她没有接受抗结核治疗。在9个月后患者返回Avicenna MC，采用腹腔镜切除萎缩的肠道储液罐，形成Bricker输尿管油切开术，近期和长期（随访10个月）效果良好。

作者简介

Denis Kholtobin

Novosibirsk Research Institute of Tuberculosis; Avicenna Medical Center

Email: urology-avicenna@mail.ru
ORCID iD: 0000-0001-6645-6455
SPIN 代码: 5473-4282
Scopus 作者 ID: 54889009300

Cand. Sci. (Med.), Urologist

俄罗斯联邦, 81A Okhotskaya str., 630040, Novosibirsk; Novosibirsk

Ekaterina Kulchavenya

Novosibirsk Research Institute of Tuberculosis; Novosibirsk State Medical University

编辑信件的主要联系方式.
Email: urotub@yandex.ru
ORCID iD: 0000-0001-8062-7775
SPIN 代码: 5244-4960
Scopus 作者 ID: 6505712683

Dr. Sci. (Med.), Professor

俄罗斯联邦, 81A Okhotskaya str., 630040, Novosibirsk; Novosibirsk

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2. 图.1.唯一左肾的腹腔镜海绵体切开术：腔底和腔壁可见 Fig. 1. Laparoscopic cavernotomy of a solitary left kidney: the bottom of the cavity and the excised wall of the cavity are visible

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3. 图.2.输尿管排入疤痕改变的水库 Fig. 2. The ureter flows into the scar-altered reservoir

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4. 图.3.皱纹水库肠系膜交汇处 Fig. 3. Intersection of the mesentery of the wrinkled reservoir

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5. 图.4.左侧输尿管流入的蓄水池的残余物 Fig. 4. Remains of the reservoir into which the left ureter flows

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