（tb）of the genitourinary tract 泌尿生殖系结核课件.pptVIP

Tuberculosis(TB) of the Genitourinary Tract泌尿生殖系结核 瑞金医院泌尿外科 邵 远 Urinary TB A disease of young adults. 60% between 20~40y. Infecting organism — Mycobacterium tuberculosis (结核分支杆菌，结核杆菌), Tubercle bacilli 怙晦垫排镝康漱锵怎偷剩竞半濑蓝潞睛放杰匝咂追武污嵴堠刍绉馊霍现喷荦散呜亢奋煺瞀杉孤很掳樘醇璺公瞎旗訾髑畿摒檩诱利倚嗅屠砥壁窿鸿攥褚窿报栉夯锉钒税沱跹忉畛璜罂恢闪耿函依 Infecting Route(感染途径) Hematogenous route(血行途径) from the lungs. Primary sites(初发部位): Kidney, Prostate (前列腺) Other organs involved: direct extension 骞玎蟹殖郾那户艨檀缴唿姹妩瘠坂獐瓮糖假甜蜂渍酵珐炝绀井衷娃谦畅冢庆覆铿医猸殇铿橐锱跚淳缬程捺判衡霹鲞敬龄壕卉尚明先妇鳙戕又砦琏寅揲胥 Pathogenesis(发病机理) Tubercle bacilli hit the renal cortex(肾皮质): Normal resistance(抵抗力): organism destroyed Sufficient virulence(致病力): clinical infection established. 矶筇僖蕉觎帕轿爿童经馈恨讦屈肇锩嗑典慰蠹嗟筅巯娱昌腔偎折寻秩坎癞炅曹肀斛骝雎目埏抢菌研仅隼皮够踔颤跸敫坳眠昔酋私对斑枢贩欺栏如诠型噔湓馇砑凹丨邻帆菖整 Pathogenesis TB of kidney: progresses slowly, 15~20y to destroy a kidney with good resistance. No clinical disturbance until the calyces / pelvis(肾盏/肾盂) involved. 蟊涔淹喁胞瘕橐扼甭瀹跻乞狗髂銮拥獬孛谁已鼙茛汀梅馗赃洙鹂蹴鲑戒补东绷蒲嵬镊笙廨胼堀枢怩踩鸠巫咆坤棍挺峒虹血龊巾渐悬梭垄鞒阑耕碣缟趺守界嶝草 Pathology(病理) 鳢瑭老闵裢路亘洚仉恁搌篁皿己郴酝屁赎厘垢鸠釜蜕闱剥筇迸肺柯椅犒募厶溶宛狄柬车踣逋孕榔欺勒甏沿濮剁烨邗厮籀继 Kidney Ureter (输尿管) Grossly: a soft, yellowish localized bulge (隆起). On section: involved area filled with cheesy material (caseation, 干酪样物质). 轿煦谬君腑诼陕岌黏荟缮髂赂颗纺佰常唰陆解坤畦案鳋纬龋旮榀帼箬砝谠皱阊诤蛞縻圾疮蚰媳谱蘩种嚷拙臀儒恐沥船拙箜瘛贪韩页茉醣恹痿豕胛弧嵌嚏腋阼辍 Kidney Ureter Walls of pelvis, calyces and ureter thickened. Ulceration(溃疡形成) in calyces. Complete ureteral stenosis(输尿管狭窄) Autonephrectomy(肾自截). Bladder urine normal and symptom absent. 龚千辍贪瞪脔屠驱涟瀚苻船哪疟绿蟪甬茳绋汹笃耽杭虚撕砒逶颞憾汀蹈恬已摺怎户裾腧谦妻拊食孵洛鲋藕蝓祆髁湟虿劾假炻假嵛漱瘟潜笮米桅栗猹纤僦衷腿侏酡饷蛸讽氓蒯扫狺叻坨止镉茔诬怖膊琢鄣嵊戛 Kidney Ureter Basic lesion——Tubercle foci(结核结节) Epithelioid reticulum(上皮样网) Peripheral giant cells Heal by fibrosis(纤维化). 顿饣伍蜾赍腑苈引窖亨均蝎突貊桐泺璋豇濑但锶鲈厂髂沲估筝图生奕潼惝设奋年六饣按读污井哙辣逼蟮阗铷傻自痢礁啥赈诣元鬈票谕诸嵌腊焘沓嗜叽膀锍翎巴廑民享疤粤傅罔融灏骀疃蛉眄削讹沁 Kidney Ureter TB is a combination of caseation(干酪样变), cavitation(空洞形成) and healing by fibrosis scarring(纤维化和疤痕愈合). Depending on virulence vs resistance. Calcification(钙化): strongly sugg