气管支气管结核的支气管镜诊治分析

目的分析46例气管支气管结核患者诊治情况及分析诊治过程中误诊、延迟诊断原因。方法分析46例患者支气管镜检查前误诊病因、镜下表现与刷检、黏膜活检、临床表现、气道狭窄情况。结果非呼吸专科医师就诊或诊所就诊39例,至诊断气管支气管结核时间1月~3年,中位数时间42天;2例患者首次支气管镜检查就发现中心气道狭窄,治疗后共有5例患者出现不同程度气道狭窄。7例患者住院支气管镜检查后诊断支气管结核,诊断气管支气管结核中位数时间为7.5天,治疗后未发生气道狭窄。两组在诊断时间上比较,P0.05,差异有统计学意义;两组在气道狭窄发生率上比较,P0.05,差异无统计学意义。结论气管支气管结核容易被非呼吸专科医师误诊,提高医师认知,及时行支气管镜检查、治疗,才能减少并发症的发生。

Analysis of bronchoscopy in the diagnosis and treatment of tracheobronchial tuberculosis

Objective To analyze the causes of misdiagnosis and delayed diagnosis of tracheobronchial tu-berculosis ( TBTB) , in order to decrease the misdiagnosis rate and the incidence of airway stenosis. Methods The misdiagnosis causes before bronchoscopy, endoscopic manifestation and brush biopsies, mucosal biopsies, clinical manifestation, and the incidence of airway stenosis were analyzed retrospectively among 46 patients with TBTB. Re-sults The diagnosis time of 39 cases, who were initially treated by non-respiratory specialists or at clinic, was from 1 month to 3 years, with the median time of 42 days. 2 cases of central airway stenosis were found by bronchoscopy for the first time, and after treatment, a total of 5 patients were found to have airway stenosis in varying degrees. 7 patients, initially treated by respiratory specialists in hospital, were diagnosed TBTB by bronchoscopy with the medi-an time of 7. 5 days, and did not occur airway stenosis after treatment. The diagnosis time in the two groups was sta-tistically different (P<0. 05). There was no significant difference in the incidence of airway stenosis (P>0. 05). Conclusion The patients with TBTB treated by non-respiratory specialists are easily misdiagnosed. So we must have to raise the awareness that timely bronchoscopy and therapy can manifestly reduce the complications of TBTB.