第126课结核（Tubercul...

第126课结核（Tubercul...上期试题：对诊断肾结核最有意义的检查项目是dA．B超B．肾图C．尿路平片D．静脉尿路造影E．膀胱镜检本人正在准备视频内容的录制，因个人能力时间有限，我会尽快和大家见面，主要内容以基础解剖和病理生理问题出发，大家一起学习，一起进步，大家有好的建议和意见都可以告诉我。

谢谢大家的支持！这期说说输尿管结核的问题；输尿管结核多继发于肾结核，病变造成肾盏和肾盂破坏后，可向下蔓延引起输尿管壁增厚、僵直和管腔狭窄、闭塞等改变。

Ureteral tuberculosis secondary to renal tuberculosis, pathological changes after destruction, calyces and renal pelvis can spread down cause of ureteral wall thickening, rigidity and luminal stenosis, occlusion, etc.输尿管结核在腹部X线平片上多无异常表现，有时可见钙化影，在输尿管下段常见，特点为沿输尿管走行区的不规则条索状、双轨状致密阴影，钙化段的输尿管僵直、缩短、扩张。

此外，输尿管结核的钙化常与肾结核钙化、肠系膜淋巴结钙化同时存在。

极少数情况下，由于输尿管增宽及管腔内积脓，可以显示为输尿管走行区的纵行条状较高密度影。

Ureteral tuberculosis in abdominal X-ray plain film in many no abnormal performance, sometimes calcification shadow, in the lower ureter, common features to line up the ureter to the area of irregular strip funicular, double-track dense shade,calcification segment rigidity, shortened, and the expansion of the ureter. In addition, the calcification of ureteral tuberculosis often associated with renal tuberculosis calcification, mesenteric lymph node calcification exist at the same time. Rare cases, due to ureteral empyema broadening and lumen, can display the direction of longitudinal bars for ureteral relatively high density shadow.尿路造影时，早期输尿管结核主要表现为输尿管扩张，粗细不均，管壁边缘欠光滑、模糊，形成锯齿状、虫蚀状等改变。

中晚期输尿管结核纤维瘢痕收缩可见输尿管多处狭窄，其中狭窄段与扩张段交替并存的征象具有一定的特征性，还可见病变的输尿管呈螺旋状、串珠状，输尿管僵直、缩短；重度输尿管狭窄可激发患侧肾盂和输尿管显影浅淡、延迟或不显影。

此时行逆行造影可显示输尿管狭窄。

Urinary tract imaging, early ureteral tuberculosis mainly for ureteral expansion, uneven thickness, tube wall edge owe smooth, fuzzy, form a jagged, insect damage shape change, etc. Middle-late ureteral tuberculosis fibrous scar contraction more than visible ureteral stricture, including narrow segment and expansion is juxtaposed signs have certain characteristic, also visible lesions of ureteral spiraling, beaded, ureteral rigidity, shorten; Severe ureteral stricture can stimulate lateral renal pelvis and ureter development shallow light, delay or no enhancement. Line of retrograde urethrography ureteral stricture display at this time.↑ 输尿结核逆行X线造影可见右侧肾盂、输尿管明显扩张积水，边缘不规则；输尿管可见多处狭窄，下段僵直，部分边缘呈锯齿状多层螺旋CT可以实现快速的大范围、长距离扫描，加之高质量的后处理重组图像，有助于全面客观的显示输尿管结核的部位、范围与相应的病理变化。

CT平扫表现为肾盂、输尿管不同程度的扩张，输尿管中下段狭窄，输尿管管壁增厚，周围脂肪间隙模糊；增强扫描可见增厚的输尿管管壁环形强化但上述征象需结合同侧肾结核的典型表现和临床资料才能提示输尿管结核的诊断。

当CT显示沿输尿管走行的输尿管壁条索状或双轨状钙化时更有助于输尿管结核的诊断。

在肾功能良好的情况下，CT尿路造影（CT Urography）可以更加直观的显示输尿管结核的狭窄和扩张，以及输尿管增厚和钙化的情况。

MDCT can achieve rapid large-scale, long-distance scanning, combined with the high quality of restructure image post-processing, help to comprehensive and objective according to the site of ureteral tuberculosis, scope and corresponding pathological changes. CT scan showed renal pelvis and ureter expansion of different level, ureteral middle period of narrow, ureteral wall thickening, fat gap around vague; Enhanced scanning visible ureteral wall of annular thickening reinforcement but the signs should be combined with a typical manifestation of ipsilateral renal tuberculosis and clinical data to suggest the diagnosis of ureteral tuberculosis. When CT showed along lines of ureteral wall funicular or ureteral dual-track shape calcification in more help to the diagnosis of ureteral tuberculosis. In the case of renal function, urinary tract CT imaging (CT Urography) can be more intuitive display the narrow and expansion of ureteral tuberculosis, and the situation of the ureter thickening and calcification.↑ 输尿管结核CT增强扫描，可见左侧输尿管管腔扩张，管壁增厚，呈环形强化当肾结核导致肾功能严重受损或功能完全丧失时，排泄性尿路造影可能输尿管不显影或加重肾功能的受损，此时宜选择MRI检查，尤其是磁共振尿系水成像(MR Urography)技术，可在不注射对比剂的情况下，形成与X线尿路造影相似的图像，可以较好的显示输尿管结核导致的形态变形、狭窄部位、病变范围以及扩张积水等改变。

When renal tuberculosis result in kidney damaged or lost, the discharge urinary tract imaging may not ureteral enhancement or aggravate the damage to the kidney, the appropriate choice MRI, especially magnetic resonance urinary system water imaging (MR Urography) technology, but in the case of no injection of contrast material, the formation of urinary tract imaging X-ray and the similar images, can better display form deformation caused by ureteral tuberculosis, parts of stenosis and pathology of the scope and the expansion water change, etc.↑输尿管结核MRU可见左侧输尿管扩张积水、粗细不均，左肾盏亦扩张积水医学博士专栏第十八期：来自罗杰斯博士的建议之焦虑症每个人都经历过‘正常’焦虑，它与15%的人患有的真正的焦虑症不一样。

当我们接受检测或遇到挑战时，正常的焦虑警告我们有潜在的危险，让我们准备好应对危险。

而焦虑症就像是假警报，让我们突然感到危险，使我们躲避某些不需要避开的情况。

不过，结合药物和心理疗法来治疗这种焦虑症，尤其是针对某种特殊行为或想法，十分有效。

有时医生未能察觉患者表现出的症状是由焦虑症引起的；有时焦虑症患者因为自己得了‘精神’问题感到尴尬，因而拒绝接受治疗。