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。

Clinical analysis of 42 patients with tracheobronchial tuberculosis

Objective To investigate the clinical characteristics of tracheobronchial tuberculosis.Methods The clinical data of 42 patients with tracheobronchial tuberculosis during recent 7 years were retrospectively analyzed,including 17 cases of male and 25 females.Results The preoperative positive rate of acid-fast bacilli in sputum was 11.9%,and the postoperative positive rate was 16.7%.There were 9 cases of granuloma by biopsy and 23 positive cases by brushing.The positive rate was 76.2% by fiberoptic bronchoscopy,which was obviously higher than that of preoperative detection for acid-fast bacilli in sputum（P〈0.05）.3 months after the treatment,the negative change rate of sputum bacteria was 66.7%（28 /42）.The total effective rate was 83.3%.There were 7 patients who were treated with lobe removal surgery or bronchial balloon dilatation.Conclusion The most sensitive and effective method to diagnose tracheobronchial tuberculosis is bronchial biopsy and brushing combined with bacterial examination by fiberoptic bronchoscopy.