支气管结核248例临床分析

目的 探索气管、支气管结核的临床特征及诊断治疗手段。方法 分析248例1993－2000年住院气管支气管结核病例资料临床表现、影像学、纤支镜检查，治疗结果。结果 248例患者中15－34年龄组青年女性明显高于其它组占69．2％（72／104）。左侧支气管病变多于右侧。影像学、纤支镜、实验室检查确诊234例，肺切除术后病理确诊14例。全组病例均予规范抗结核化疗，其中并用雾化治疗72例。经纤支镜支气管腔内给药26例有效率84．6％。外科治疗47例。结论 纤支镜检查是诊断气管支气管结核最重要的方法。在实施规范抗结核化疗同时并用雾化及经纤支镜支气管内给药治疗，是改善临床症状，减轻或消除支气管狭窄的有效方法。对不可逆结核性支气管狭窄、肺不张及严重肺功能损毁患者应及时外科治疗。     

支气管结核248例临床分析

目的 探索气管、支气管结核的临床特征及诊断治疗手段。方法 分析1993年1月至2000年10月248例气管支气管结核住院病例资料临床表现、影像学、纤支镜检查结果。结果 248例患者中15－34年龄组青年女性明显高于其它组占69.2%(72/104)。左侧支气管病变多于右侧。影像学、纤支镜、实验室检查确诊234例，肺切除术后病理确诊14例。全组病例均予规范抗结核化疗，其中合并雾化治疗72例。经纤支镜支气管腔内给药的26例有效率84.6%。外科治疗47例。结论 纤支镜检查是诊断气管支气管结核最重要的方法。在实施规范抗结核化疗同时合并雾化及经纤支镜支气管内给药治疗，是改善临床症状，减轻或消除支气管狭窄的有效方法。对不同逆结核性支气管狭窄、肺不张及严重肺功能损毁患者应及时外科治疗。     

纤维支气管镜下局部注药治疗气管、支气管结核的疗效观察

目的　为探讨气管、支气管结核纤维支气管镜 (简称纤支镜)下注药加化疗的临床疗效。方法 对经纤支镜检查、痰找抗酸杆菌以及临床明确诊断的气管、支气管结核分为化疗加纤支镜下注药治疗组和单纯化疗组,观察两组疗效,以及镜下不同类型有效率比较。结果 治疗 2个月后纤支镜组的临床症状、胸部X线表现、痰菌阴转率以及纤支镜下改变与单纯化疗组比较有非常显著性差异及显著性差异 (P＜0.01,P＜0.05),治疗 6月后痰菌阴转率及纤支镜下改变纤支镜组与单纯化疗组比较有显著性差异 (P＜0.05),镜下分型以肉芽增殖型、溃疡坏死型纤支镜组优于单纯化疗组,支气管炎型和瘢痕狭窄型纤支镜组与单纯化疗组对比无显著性差异。结论 肉芽增殖型、溃疡坏死型气管、支气管结核可采取化疗加纤支镜下注药,该治疗方法不仅能迅速缓解病人临床症状,而且能促进病灶吸收,提高临床疗效。     

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。     

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。     

支气管结核单纯化疗和介入综合治疗近期效果观察

目的　探讨经支气管镜介入局部注药及高频电清除的方法 治疗支气管结核的效果。方法 97例支气管结核病人在全身抗结核治疗基础下随机分为3组,即单纯化疗、支气管镜下进行高频电治疗和局部注药介入治疗进行近期效果观察。结果 高频电组:平均治疗1.8次,有效率97.7%;局部注药组。平均治疗9.1次,有效率88.5%;单用抗结核治疗,有效率55.5%。结论 支气管结核临床易漏诊,经支气管镜介入局部注药或高频电加局部注药治疗均有良好的治疗效果,而后者更快速有效。     

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。     

肺结核合并支气管结核97例临床分析

目的探讨肺结核合并支气管结核的临床特点。方法回顾性分析97例肺结核合并支气管结核临床资料。结果临床以咳嗽(82.5%)、咳痰(80.4%)、发热(45.4%)、不同程度咯血或血丝痰(23.7%)等为主要症状,胸部CT以肺不张或膨胀不全(44.2%)及浸润增殖性病灶(37.9%)为主要表现,并可见支气管狭窄阻塞、支气管扩张、支气管播散、支气管充气征、纵隔淋巴结增大、纵隔淋巴结钙化等表现,痰涂片或培养检查抗酸杆菌阳性率较高(63.9%),尤其在多叶段浸润增殖病灶患者中其阳性率高达83.3%。纤支镜检查以主支气管及叶支气管开口受累显著(64.8%),多气管支气管受累患者达81.4%,且多种支气管镜下表现类型并存,纤支镜刷检抗酸杆菌、组织活检阳性率分别为55.9%、69.4%。接受纤支镜介入治疗的患者仅有18例,其中6例支气管狭窄闭塞并肺不张患者行气管镜下支气管球囊扩张术治疗,5例支气管狭窄好转。结论肺结核合并支气管结核患者临床表现无特异性。胸部CT对观察支气管损伤及淋巴结病变能提供较大帮助。气管镜检查仍为其重要诊断手段,镜下可见多气管支气管受累,且镜下表现类型相互重叠。球囊扩张术可有效改善支气管狭窄。     

支气管镜介入冷冻治疗支气管结核

目的　探讨支气管镜下冷冻治疗支气管结核的疗效。方法 21例支气管结核患者常规抗结核化疗基础上,在支气管镜下行冷冻和镜下注药治疗并追踪观察。结果 21例支气管结核患者行支气管镜下冷冻和镜下注药治疗,平均治疗5±2次/例。18例溃疡坏死型和/或肉芽增殖型患者经治疗后,支气管黏膜光滑、管腔通畅,原有阻塞性肺炎、肺不张消退,症状消退或明显改善,仅3例患者支气管腔内遗留少量瘢痕组织,不影响通气功能。显效83.3%(15/18)、有效16.7%(3/18),总有效率100%(18/18)。而3例瘢痕型经多次冷冻治疗后,病变无变化,症状无改善。结论 肉芽增殖型和/或溃疡坏死型支气管结核采用支气管镜下介入冷冻治疗不仅能迅速缓解病人临床症状、促进病灶吸收,通畅呼吸道,还可有效地控制肉芽增生,避免瘢痕纤维组织形成的气道狭窄或闭锁等不良后果。但对于肉芽增生进入瘢痕纤维组织形成后,冷冻治疗则难以奏效。故对于支气管结核患者应争取尽早诊断、尽早治疗,纤支镜介入冷冻治疗支气管结核是一种无明显并发症和不良反应,安全有效的方法。     

经纤支镜诊断菌阴肺下野结核60例及其误诊分析

目的　探讨纤维支气管镜检查在菌阴肺下野结核中的诊断价值及其误诊中的临床意义。方法 对 60例曾经被误诊,后经纤支镜检查确诊的肺下野结核的临床资料进行回顾性分析。结果 60例患者纤支镜下表现:中、下叶支气管粘膜慢性炎症最多见,分别为 25例 (41.7%)和 20例(33.3%),其次为管口狭窄 7例 (11.7%)。四种方法联合检出的 60例肺结核中,单纯刷检抗酸杆菌阳性 37例 (61.7%)；刷检+支气管肺泡灌洗 (BAL)阳性 46例 (76.7%)；BAL+镜检后痰检 +组织活检诊断肺结核 52例 (86.7%)。结论 纤支镜检查能提高菌阴肺下野结核的诊断率,刷检、灌洗、组织活检及镜查后痰检可互相补充以提高诊断的阳性率,避免误诊。     

经纤支镜诊断46例支气管结核临床分析

目的　探讨纤维支气管镜在支气管内膜结核早期诊断中的作用。方法　 1995年 1月～ 2 0 0 2年 12月经纤维支气管镜 (纤支镜 )活检或刷检确诊支气管内膜结核 4 6例患者进行临床特点和纤支镜结果统计分析。结果　 4 6例病人均证实为支气管内膜结核。 8例痰涂片找抗酸杆菌阳性 ,38例行纤支镜刷检找抗酸杆菌阳性 ,11例活检证实为结核。纤支镜检查示炎症浸润型 4 1.3% ,增殖型 13.0 % ,狭窄闭塞型 2 6 .1% ,溃疡型 15 .3% ,正常 4 .3% ,纤支镜刷检阳性率高于痰涂片检查和活检 (P<0 .0 1)。结论　支气管内膜结核缺乏特异性临床表现 ,X- CT诊断价值不高 ,纤支镜检查成为支气管内膜结核早期诊断的主要措施。     

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     

Clinical investigation on endobronchial tuberculosis]

In order to assess the clinical features and clinical courses of endobronchial tuberculosis, which included trachea to segmental bronchus, we studied 34 cases of patients who were admitted to TB ward of International Medical Center of Japan from 1994 to 1997. We noticed a higher incidence in females and in the main bronchus. Cough was the most common complaint seen in 97% of cases. The duration of symptoms before the initiation of antituberculous chemotherapy was long (on the average 6 months), and they were often treated as bronchial asthma or bronchitis. Bronchoscopic examination is necessary for diagnosis. The scars sometimes gave rise to severe stenosis, especially when the lesion developed to an advanced stage or circumscribed the lumen before treatment. We tried INH inhalation with systemic chemotherapy. Although rapid improvement was suggested by this method, yet no significant difference was seen in the results for the efficacious prevention of stenosis. Five cases required surgical intervension (bronchoplasty and lobectomy) in order to avoid atelectasis or secondary infection. Early diagnosis and appropriate treatment are most important, and bronchoscopic examination is essential in early diagnosis.     

纤维支气管镜下钳夹加注药治疗支气管结核223例疗效观察

目的观察及分析纤维支气管镜下钳夹加注药治疗支气管结核（溃疡及干酪坏死型及肉芽增生型）的疗效。方法我科自2009年3月至2010年7月,共发现支气管结核（溃疡及干酪坏死型及肉芽增生型）223例。均采用HREZ方案全身抗结核治疗（根据药敏试验加或不加左氧氟沙星）。并予抗结核药物雾化吸入局部治疗,纤维支气管镜下钳夹坏死物及肉芽组织,并在病变支气管内注入抗结核药物。观察治疗后镜下表现的变化。结果本组223例患者,全吸23例（占10.31%）,显效96例（占43.05%）,有效101例（占45.29%）,不变3例（占1.35%）,无恶化病例。总有效率98.65%,而无效率仅为1.35%。结论纤支镜下钳夹加注药治疗支气管结核疗效确切、并发症少、对避免形成气道瘢痕、狭窄、肺不张等后遗症有着良好的效果。     

Predictors of persistent airway stenosis in patients with endobronchial tuberculosis.

SETTING: The university and municipal hospitals in Seoul, Korea. OBJECTIVE: To evaluate the predictors of persistent airway stenosis following anti-tuberculosis chemotherapy in patients with endobronchial tuberculosis (TB). DESIGN: Diagnosis of TB was confirmed by microbiology or histopathology. Bronchoscopic examinations revealed that patients had endobronchial lesions compatible with endobronchial TB. Study subjects had at least one follow-up bronchoscopy to evaluate their treatment response. Treatment response was determined by changes in the degree or extent of airway stenosis between the first and last bronchoscopic examinations. RESULTS: Sixty-seven subjects were recruited retrospectively from Seoul National University Hospital and Seoul National University Boramae Hospital. Persistent bronchostenosis occurred in 41.8% of the patients. In multivariate regression analysis, age >45 years (OR 3.65), pure or combined fibrostenotic subtype (OR 5.54) and duration from onset of chief complaint to the initiation of anti-tuberculosis chemotherapy >90 days (OR 5.98) were identified as independent predictors of persistent airway stenosis. Oral corticosteroids (prednisolone equivalent >or=30 mg/d) did not reduce the frequency of persistent airway stenosis. CONCLUSION: Early diagnosis and early administration of anti-tuberculosis chemotherapy before involvement of the deeper airways is important to prevent the development of unwanted sequelae of bronchostenosis.     

Prospective study of corticosteroid as an adjunct in the treatment of endobronchial tuberculosis in adults

Abstract Although endobronchial tuberculosis frequently causes bronchial stenosis, there are no specific therapies to prevent the sequelae. The use of corticosteroids remains controversial and there have been no prospective comparative studies about the effectiveness of corticosteroids. This study was undertaken in order to determine the effectiveness of corticosteroids in the prevention of complications of endobronchial tuberculosis. Thirty-four patients with endobronchial tuberculosis who were admitted to Chung-Ang University hospital from March 1991 to December 1995 were evaluated prospectively to determine the effect of corticosteroid in the treatment of endobronchial tuberculosis. All patients were randomly divided into two groups: group 1 ( n =17, anti-tuberculosis chemotherapy only) and group 2 ( n = 17, combining anti-tuberculosis chemotherapy with oral corticosteroid). Serial bronchoscopies, pulmonary function tests and chest roentgenograms were analyzed every 2 months until the complete resolution of endobronchial tuberculosis. Before treatment commenced there were no significant differences between the two groups with respect to sex, mean age, pulmonary function, chest roentgenogram and morphologic patterns of endobronchial lesion. After treatment, the healing rate of bronchoscopic findings and changes in pulmonary function showed no significant differences between the two groups. Radiologic improvements were observed in all eight patients (five in group 1 and three in group 2) with segmental atelectasis on chest roentgenograms after 2 months of treatment. This study suggests that corticosteroid therapy would not influence the outcome of endobronchial tuberculosis and that prompt treatment with early diagnosis, before formation of fibrosis would be necessary to prevent complications of endobronchial tuberculosis, such as bronchostenosis.     

A case of asymptomatic endobronchial lipoma followed for 4 years]

Bronchoscopy was performed on a 68-year-old male patient with pulmonary tuberculosis, and revealed a yellow smooth polypoid tumor in the lumen of the left upper division bronchus. The histopathological diagnosis of the biopsy specimen was endobronchial lipoma. Since the patient did not have any symptoms due to the lipoma, we performed treatment for tuberculosis and continued careful observation of the tumor. During the subsequent 4 years, the patient developed no complications such as obstructive pneumonia, and the size of the tumor under bronchoscopic observation did not change. Endobronchial lipoma is a very rare benign tumor. Almost all reported cases have undergone operation or endoscopic surgery. This case is the first that was followed over 4 years without surgical procedure. The findings of follow-up bronchoscopic examination suggest that the growth rate of endobronchial lipoma is very slow. Furthermore, we reviewed 36 cases of endobronchial lipoma in the Japanese literature, including our case. Smoking seems to have a strong relation to the occurrence of the tumor. It is noteworthy that 6 cases had separate malignancies, but the direct relationship between endobronchial lipoma and such malignancies is unclear.