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。

Clinical analysis of 90 cases with endobronchial tuberculosis

Objective To explore the clinical features and early definite diagnosis of endobronchial tuberculosis(EBTB). Methods Clinical symptoms, chest Xray/CT manifestations and fiberoptic bronchoscopic findings of 90 cases with EBTB were analyzed. Results Main symptoms were as follows: cough in 75 cases, fever in 27, haemoptysis in 24, pleural pain in 18, dyspnea in 11, weight loss in 7, etc. Signs of airway obstruction were rare, localized wheezing was found only in 2 cases . 7 cases in chest Xray were normal, and only 2 cases in CT were indicative of EBTB. Bronchoscopic results showed exudative lesions in 38% of the cases,granulomatous lesions in 9% ,cicatricial lesions in 26%, ulcerative lesions in 17% , and normallike demonstrations in 11%. Positive results were found in 8 out of 50 by sputum acidfast staining, 73 out of 86 by bronchoscopic brushing smears, and 17 out of 56 by bronchial biopsies. Conclusions The clinical features of EBTB are nonspecific, and EBTB can not be excluded only by normal chest Xray findings. In contrast to CT, bronchoscopy plays an important role in definite diagnosis of the disease. When patients with slight fever of unknown origin or respiratory symptoms do not respond to general treatment, EBTB should be suspected and early fibereoptic bronchoscopy be performed. Fiberoptic bronchoscopic brushing examination for acid fast bacillus and bronchial biopsy are beneficial to rapid and definite diagnosis of EBTB.