单纯性支气管内膜结核临床及纤维支气管镜下特点分析

目的探讨单纯性支气管内膜结核的临床及纤维支气管镜下特点。方法回顾性分析本院经纤支镜检查后确诊单纯性支气管内膜结核66例的临床、X线和纤支镜下表现。结果主要症状为干咳,少数伴咳痰、咯血、发热、气急,体征有局限性干啰音,呼吸音减弱,少数呈广泛哮鸣音。X线表现为肺不张,肺内块状阴影,16例(24%)患者胸片无异常发现。纤支镜下所见分为浸润型,溃疡型,肉芽增殖型,疤痕型。钳检病理学阳性率62.7%,刷检物涂片抗酸杆菌阳性率74.6%。结论单纯性支气管内膜结核的临床症状与X线表现无特征性,纤支镜检查中联合活检组织病理及刷检物涂片抗酸杆菌检测是有效的诊断手段。     

胸片正常的支气管内膜结核15例临床分析

目的 探索胸片正常的支气管内膜结核的临床特征及早期确诊手段。方法 分析15例经纤维支气管镜(纤支镜)确诊的支气管内膜结核患者的临床表现、胸部X线(平片)及CT片、纤支镜检查结果。结果 15例中主要症状包括：咳嗽15例，气促5例，胸痛4例，发热3例，咯血2例，消瘦2例。15例的X线胸片正常。纤支镜检查示46．7％的病例有炎性浸润型病变，33．3％有增殖型病变，13．3％有溃疡型病变，6．7％有狭窄闭塞型病变。15例痰涂片行抗酸染色者中3例阳性，痰培养阳性1例；纤支镜刷片检查8例阳性，活组织检查7例证实为结核。结论 支气管内膜结核无特异性临床表现及胸部X线表现正常不能排除支气管内膜结核，确诊主要依靠纤支镜检查。对不明原因发热和呼吸道症状经积极治疗无效者，应怀疑支气管内膜结核而及时行纤支镜检查。通过镜下常规刷检找抗酸杆菌配合组织活检确诊率高。     

纤维支气管镜检查对无痰或痰菌阴性不典型肺结核的诊断价值

目的 探讨纤维支气管镜（简称“纤支镜”）检查对无痰或痰菌阴性不典型肺结核的诊断价值。 方法 选无痰或痰菌阴性的不典型肺结核患者201例,用纤支镜在病变部位进行活检、刷检、支气管肺泡灌洗液（BALF）进行BBLMGIT(Mycobacteria Growth Indicate Tube)分枝杆菌快速培养查结核杆菌。术后进行痰涂片查抗酸杆菌、痰结核分枝杆菌快速培养。 结果201例刷检、BALF快速培养结核分枝杆菌阳性率分别是67.2%、83.6%,61例活检阳性率63.9%,201例术后痰涂片、术后痰快速培养结核分枝杆菌阳性率分别是28.9%、57.2%。 结论 纤支镜检查是确诊无痰或痰菌阴性不典型肺结核的有效方法 ,其中BALF行结核分枝杆菌快速培养具有较高的诊断价值、快速、阳性率较高。根据镜下所见采用不同的取材方法 可望提高诊断率。     

菌阴肺下野结核纤支镜诊断及其误诊分析

目的研究菌阴肺下野结核的纤支镜镜检的诊断价值。方法分析49例误诊的患者行纤支镜而确诊的肺下野结核。结果49例纤支镜镜检下表现中下支气管慢性炎症最多见,占40例(81.67%),其次为管口狭窄5例(10.2%),刷检抗酸杆菌阳性31例(63.24%),镜检后痰检抗酸杆菌阳性24例(48.97%)。活检5例(10.2%)。结论纤支镜检查能提高菌阴肺下野结核的诊断率,刷检、活检及镜后痰检可互补,更能提高诊断的阳性率,避免误诊误治。     

纤支镜灌洗液的结核分支杆菌快速培养对不典型肺结核的诊断价值

目的　评价纤维支气管镜(以下简称纤支镜)支气管肺泡灌洗液(BALF)的结核分支杆菌快速培养对不典型肺结核的诊断价值。方法 选无痰或痰菌阴性的不典型肺结核患者49例行纤支镜检查,进行活检、刷检、BALF经BBLMGIT分支杆菌快速培养查结核杆菌。结果 49例经纤支镜刷检、BALF快速培养结核分支杆菌检出率分别是67.4%、83.7%,其中15例经纤支镜肺活检,10例病理证实为结核肉芽肿,检出率为66.7%。结论 纤支镜对无痰或痰菌阴性下BALF行结核分支杆菌快培对不典型肺结核具有较高的诊断价值,快速,阳性率较高。根据镜下所见采用不同的取材方法可望提高诊断率。     

纤支镜灌洗液的结核分支杆菌快速培养对不典型肺结核的诊断价值

目的：评价纤维支气管镜(以下简称纤支镜)支气管肺泡灌洗液(BALF)的结核分支杆菌快速培养对不典型肺结核的诊断价值。方法：选无痰或痰菌阴性的不典型肺结核患者49例行纤支镜检查，进行活检、刷检、BALF经BBL MGIT分支杆菌快速培养查结核杆菌。结果：49例经纤支镜刷检、BALF快速培养结核分支杆菌检出率分别是67．4％、83．7％，其中15例经纤支镜肺活检，10例病理证实为结核肉芽肿，检出率为66．7％。结论：纤支镜对无痰或痰菌阴性下BALF行结核分支杆菌快培对不典型肺结核具有较高的诊断价值，快速，阳性率较高。根据镜下所见采用不同的取材方法可望提高诊断率。     

气管支气管结核42例诊治体会

目的探讨气管支气管结核的临床特征及诊治体会。方法分析7年来42例门诊及住院病人临床确诊的气管支气管结核临床资料,结合其临床、病理表现及治疗情况等进行总结。结果术前痰找抗酸杆菌阳性5例(11.9%),术后阳性7例(16.7%);活检见肉芽肿9例(21.4%),刷检阳性23例(54.7%);纤支镜检查(刷检+活检)阳性率为76.2%(32/42),明显高于纤支镜检查前痰找抗酸杆菌阳性率11.9%(5/42),差异具有显著性(P<0.05)。本组病例经规律全身抗结核药物治疗12个月,3个月后痰菌阴转情况66.7%(28/42),根据患者的具体情况,配合雾化吸入、气管内滴入抗结核药物、及冷冻等综合治疗,获得满意疗效38例(83.3%),行肺叶摘除手术或支气管球囊扩张术手术患者7例(16.7%)。结论经纤支镜支气管内采样做病理活检+刷检、细菌学检查作为诊断TBTB最重要的手段,是诊断气管支气管结核最敏感特异方法。在规则抗结核基础上,结合纤支镜下行介入治疗对气管支气管的预后、发展将起着关键性作用。     

抗酸染色对肺结核的诊断价值

目的 了解结核分枝杆菌抗酸染色对肺结核的诊断价值。方法对98例确诊为继发型肺结核和血行播散型肺结核患者，统计分析痰液及纤支镜刷检液涂片抗酸染色情况。结果98例中抗酸染色阳性38例，阴性60例。10例经纤支镜刷检液涂片抗酸染色中，阳性6例。结论抗酸染色是诊断肺结核的常规方法，纤支镜刷检液涂片明显高于痰涂片法。     

肺结核合并支气管结核103例临床及纤支镜检查结果分析

目的探讨肺结核合并支气管结核患者的临床及纤支镜检查特点。方法回顾性分析103例肺结核合并支气管结核患者的临床资料,观察患者纤支镜检查前临床漏诊及误诊情况,比较纤支镜涂片检查、纤支镜活组织病理检查和痰涂片检查抗酸杆菌阳性率的差异。结果肺结核合并支气管结核患者临床症状有咳嗽、咳痰、发热、不同程度咯血或痰中带血;纤支镜检查前临床误诊率、漏诊率均较高;纤支镜涂片检查、纤支镜活组织病理检查和痰涂片检查抗酸杆菌阳性率比较差异有统计学意义（P均〈0.05）。结论肺结核合并支气管结核患者临床表现无特异性,纤支镜检查是其重要的诊断手段。     

支气管内膜结核90例临床分析

目的探索支气管内膜结核（ＥＢＴＢ）的临床特征及早期确诊手段。方法分析９０例经纤维支气管镜（纤支镜）确诊的ＥＢＴＢ患者的临床表现、胸部Ｘ线（ＣＴ）、纤支镜检查结果。结果９０例中主要症状包括：咳嗽７５例,发热２７例,咯血２４例,胸痛１８例,气促１１例,消瘦７例。气道阻塞症状少,仅２例出现喘息。７例的Ｘ线表现正常,只有２例的ＣＴ检查结果提示ＥＢＴＢ。纤支镜检查示３８％的病例有炎症浸润型病变,９％有增殖型病变,２６％有狭窄闭塞型病变,１７％有溃疡型病变,１１％大致正常。５６例痰涂片行抗酸染色者中８例阳性,８６例行纤支镜刷片检查者中７３例阳性,５６例行活组织检查者中１７例证实为结核。结论ＥＢＴＢ缺乏特异性临床表现,胸部Ｘ线表现正常不能排除ＥＢＴＢ,ＣＴ诊断价值不高,确诊主要依靠纤支镜检查。对不明原因低热和呼吸道症状经积极治疗无效者,应怀疑ＥＢＴＢ而及时行纤支镜检查。行镜下常规刷检找抗酸杆菌和（或）组织活检阳性率高,且简便快捷,值得推广。     

支气管结核86例临床分析

目的探讨支气管结核(EBTB)的临床特征。方法分析经纤维支气管镜(纤支镜)确诊的86例EBTB患者的临床表现、胸部X线、纤支镜检查结果等。结果纤支镜检查示大致正常仅占9%,37%有炎症浸润型病变,16%有增殖型病变,26%有狭窄闭塞型病变,12%有溃疡型病变。78例痰涂片行抗酸染色中10例阳性,86例行纤支镜刷片检查69例阳性,62例行活组织检查者中24例证实为结核。结论EBTB缺乏特异性临床表现,确诊主要依靠纤支镜检查。     

69例支气管结核临床分析

目的　探索支气管结核早期确诊手段及临床特征。方法 分析69例经纤维支气管镜 (纤支镜 )确诊的支气管结核患者临床表现、胸部X线、CT及纤支镜结果。结果 69例主要症状包括:咳嗽68例,咳痰44例,午后低热50例,盗汗49例,乏力48例,喘息18例,痰中带血13例。胸片及CT示:气管开口凹凸不平、不规则狭窄42例,有阻塞性肺炎26例,肺不张25例,肺内空洞14例,肺门淋巴结肿大11例。痰涂片结核菌阳性率为43.5%,痰结核菌培养阳性率36.2%。纤支镜示:刷检结核菌阳性率为55.1%,组织活检中56.7%证实为结核,其中40.6%为炎症浸润型,13.0%为增殖型,29.0%为溃疡型,26.1%为狭窄闭塞型。上述四种类型发现结核菌的阳性率分别为71.4%,77.8%,100%和55.6%。结论 当有支气管结核临床表现时,应行胸部X线、CT检查,对可疑病人作纤支镜。当病理、细菌学均不能明确诊断,应重复活检、刷检和试验性抗结核治疗,追踪观察以确诊。     

The value of fiberoptic bronchoscopy in diagnosis of smear negative pulmonary tuberculosis

Although mycobacterial culture positivity is the gold standard for the diagnosis, the initial approach to the diagnosis of pulmonary tuberculosis (PTbc) is the detection of acid-fast bacilli (AFB) in respiratory specimens as recommended by the World Health Organization. But the physicians have to make a decision for the patients whose sputum smears are negative or who can not produce sputum. Waiting for culture results with radiological follow up or empirical antituberculous therapy are the standard options. In our study we aimed to assess the diagnostic yield of fiberoptic bronchoscopy in patients, suspected to have tuberculosis, whose sputum smears were negative or who could not produce sputum. Fifty six patients who suspected to have PTbc with sputum smear negative were enrolled in the study (fiberoptic bronchoscopy and selective bronchial washings were done to all patients. Bronchial washings were obtained from the affected parts). Mucosal biopsies were done in patients in where endobronchial abnormalities were noted. Transbronchial biopsies were done in selected patients from the radiological localizations. Ziehl-Nielsen staining and culture in L?wenstein-Jensen medium were the microbiological studies. Typical granulomas were expected to detect on histopathologic examination. Bronchoscopic lavage smears were positive for Mycobacterium tuberculosis in 13 (23%) patients. Twenty eight (50%) patients had positive culture. Histopathological results confirmed tuberculosis in eight of 20 patients who had undergone mucosal biopsies, four of seven of transbronchial biopsies, two of three of needle aspiration biopsies. By bronchoscopic procedures early diagnosis was performed in 27 (48.21%) patients. We concluded that fiberoptic bronchoscopy has an important role in the diagnosis of patients suspected to have tuberculosis, whose sputum smears were negative or who could not produce sputum. It is useful and necessary in selected cases.     

纤维支气管镜诊断支气管结核98例分析

目的　探索支气管结核的确诊手段及临床特征。方法　分析 98例支气管结核患者的临床表现及纤支镜结果。结果　主要症状包括咳嗽 72例 (73% ) ,咳痰、咯血、气喘、胸痛、发热等。纤支镜示 :支气管刷检结核菌阳性率 85 .71% ,组织活检阳性率 6 9.2 3% ,其中 4 1.84 %以炎性浸润改变为主 ,2 2 .4 5 %以溃疡型改变为主 ,11.2 3%以增殖改变为主 ,2 4 .4 9%以瘢痕狭窄改变为主。结论　当有支气管结核临床表现及 X线表现特异性不强时 ,进行纤支镜检查。当病理、细菌学均不能明确诊断 ,可进行试验性抗结核治疗 ,追踪观察以确诊     

巢式聚合酶链反应检测支气管内膜结核患者活检组织中结核 …

目的 了解巢式聚合酶链反应（ＮＰＣＲ）技术对支气管内膜结核的诊断价值。方法 应用巢式聚合酶链反应（ＮＰＣＲ）对６７份支气管内膜活检组织进行结核分支杆菌ＤＮＡ检测。并与病理检查,刷检涂片,支气管镜检后痰涂片和痰培养结果比较,对照为４３例支气管肺癌患者,结果６７例支气管内膜结核活检组织病理检查,刷检涂片,支气管镜检“激惹”后痰涂片,镜检术后痰培养及ＮＰＣＲ检测阳性率分别为１３％,１９％,２２％,１５％     

支气管结核246例诊断和介入治疗效果分析

目的　探讨支气管结核早期确诊手段、临床特征及介入治疗。方法 分析246例经支气管镜(纤支镜)确诊的支气管结核患者临床表现、胸部X线、CT、纤支镜结果 及介入治疗效果。结果 246例主要症状包括:咳嗽183例,咳痰92例。午后低热59例,盗汗78例,乏力84例,喘息67例,痰中带血23例。X线胸片及CT示:气管、支气管狭窄96例。有阻塞性肺炎31例,肺不张55例,肺内有空洞38例,痰涂片结核菌阳性率为43.5%,痰结核菌培养阳性率为35.3%。纤支镜示:刷检结核菌阳性率为56.5%,组织活检中58.4%证实为结核,其中42.2%为炎症侵润型、10.2%为增殖型、18.7%为溃疡型、17.1%为狭窄闭塞型。治疗效果:痰菌阴转2个月90.6%,6个月100%。结论 当有支气管结核临床表现时,应行胸部X线、CT检查、对可疑病人做纤支镜检查。当病理、细菌学均不能明确诊断,应试验性抗结核治疗,追踪观察以确诊。介入治疗支气管结核疗效可靠,安全性好。     

Medical treatment for bronchial stenosis due to endobronchial tuberculosis

It is needless to say that early diagnosis and appropriate treatment for endobronchial tuberculosis are most important, and bronchoscopic examination is necessary for early diagnosis. Although endobronchial tuberculosis frequently causes bronchial stenosis, there are no specific therapies to prevent the complication. To determine the effectiveness of corticosteroids in the prevention of complication of endobronchial tuberculosis, this study was undertaken. 18 patients with endobronchial tuberculosis whose bronchoscopic findings showing ulcer formation or endobronchial polyp, out of 35 patients with endobronchial tuberculosis who were treated in Nihon University hospital from 1996 to 1998, were evaluated to determine the effectiveness of corticosteroids in the prevention of bronchial stenosis. We divided the patients into 2 groups: 11 who received systemic chemotherapy for tuberculosis only, and 7 who received systemic chemotherapy combined with oral corticosteroid. No significant differences distinguished the groups with respect to duration of positive sputum culture or reduction of respiratory symptoms. However, a significant alleviation of bronchial stenosis was observed in the patients who received systemic chemotherapy combined with oral corticosteroid. This study suggested that corticosteroid therapy in addition to standard chemotherapy for tuberculosis was effective for prevention of complication of endobronchial tuberculosis, such as bronchostenosis.     

支气管结核112例临床分析

目的探讨支气管结核（EBTB）的临床特征及支气管镜在支气管结核的诊断和治疗中的价值。方法分析112例支气管结核的临床表现、影像学表现、支气管镜下表现、病原学和病理学检查结果及通过支气管镜治疗的效果。结果支气管结核好发于年轻女性,临床表现和胸部X片及胸部CT检查均无特异性。支气管镜下五种类型均有发现。经支气管镜行刷检和活组织病理检查阳性率高。在支气管镜下分别进行局部注入抗结核药、清除坏死组织、热烧灼、球囊扩张等治疗,Ⅰ型及Ⅱ型无一例发生支气管管腔狭窄。结论支气管镜在EBTB的诊断和治疗中均有极重要的地位。