纤维支气管镜检查对支气管结核诊断价值探讨.docVIP

纤维支气管镜检查对支气管结核诊断价值探讨 　　【摘要】 目的 探讨纤维支气管镜检查在支气管结核诊断中的价值。方法 回顾性分析22例胸片正常的支气管结核患者的临床表现、诊断和治疗。结果 支气管内膜结核误诊率高,以青年女性多见,病变多累及左主支气管、两肺上叶,纤维支气管镜检查示炎症浸润型病变12例,干酪坏死型病变5例肉芽增生型型病变3例,纤维狭窄型病变2例,均行黏膜活检和刷检,经黏膜活检病理确诊16例,刷检细菌学证实9例,两者联合确诊22例。全身抗结核化疗后症状缓解率达100%。结论 纤支镜检查对气管支气管结核有重要诊断价值。 　　【关键词】 支气管镜检查;支气管结核;诊断 　　【Abstract】 Objective Investigate the using of the fiberoptic bronchoscopy in the diagnosis of bronchial tuberculosis. Methods Retrospective analysis the clinical manifestations, diagnosis and treatment of 22 cases of bronchial tuberculosis in patients with normal chest X-ray. Results The rate of misdiagnosis of endobronchial tuberculosis is high.The endobronchial tuberculosis is more common in young women,and involves the left main bronchialand two upper lungs in main.12 cases of the patients were infiltrating inflammatory lesions by fiberoptic bronchoscopy, five cases were cheese necrotizing granulomatous lesions,3 cases were proliferative lesion,and 2 cases were fiber-type lesion stenosis.All of the cases underwent mucosal biopsy and brush biopsy.And 16 cases were confirmed by mucosal biopsy;9 cases were confirmed by brushing bacteriology; 22 cases wereco-diagnosed of the two.The remission rate of the systemic anti-TB chemotherapy was 100%. Conclusion The fiberoptic bronchoscopy has important diagnostic value for tracheobronchial tuberculosis. 　　【Key words】 Bronchoscopy; Bronchial tuberculosis;Diagnosis 　　 　　支气管结核是指发生于支气管黏膜或黏膜下层的结核性病变,以往称为支气管内膜结核,近来病理学证实病变可累及管壁各层,改称为支气管结核。其临床表现、X线表现不典型,临床上易被误诊,从而延误治疗,可导致不可逆性支气管狭窄、肺不张而使肺功能受损,并可成为慢性传染源。本文报告我院自2004年1月至2008年12月间住院支气管内膜结核患者中胸片正常的支气管结核22例作回顾性总结分析,以期提高对本病的临床诊断水平。 　　1 资料与方法 　　1.1 研究对象 22例患者均为行纤维支气管镜检查,并通过刷片和(或)活检确诊为支气管结核的患者。男6例,女16例,年龄14~53岁,平均32岁,首发症状至就诊时间12 d~3年,平均4.1个月。 　　1.2 临床表现 咳嗽22例,多为干咳;咯血4例,多为痰中带血或少量咯血;胸闷气促11例,发热6例。查体肺部可闻局限性吸气相哮鸣音12例,无异常体征10例。 　　1.3 辅助检查 所有患者均行PPD试验、痰找抗酸杆菌、胸片及纤维支气管镜检查。 　　2 结果 　　2.1 22例均作结核菌素纯蛋白衍生物(PPD)皮试,强阳性10例,普通阳性8例。22例行痰涂片查抗酸杆菌3次以上,阳性者4例阳性率18.2%。 　　2.2 纤维支气管镜检查结果 均发现支气管内膜有病变。病变形态: 炎症浸润型病变12例,干酪