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支气管内膜结核52例临床分析 总被引:1,自引:0,他引:1
目的:探讨支气管内膜结核(EBTB)的临床特征、确诊方法及疗效分析.方法:回顾性分析52例经纤维支气管镜(纤支镜)确诊的EBTB患者的临床表现、胸部影像、纤支镜检查和治疗效果.结果:本组患者女多于男,临床症状主要以咳嗽、咳痰、发热、气急、咯血、胸痛为主,46.2%的患者胸部影像学无异常.纤支镜检查:右侧多于左侧,干酪样坏死型28.8%,充血水肿型23.1%,瘢痕狭窄型21.1%,肿瘤型17.3%,溃疡型9.7%.全部病例经纤支镜病理活检和(或)刷检找到抗酸杆菌确诊.经抗结核化疗临床治愈45例,7例遗留有不同程度的支气管狭窄.结论:EBTB缺乏特异性的临床表现,胸部影像学检查正常不能除外,纤支镜检查是确诊EBTB最重要的手段,EBTB早期抗结核治疗效果好. 相似文献
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目的探讨支气管内膜结核(endobronchial tuberculosis, EBTB)的CT表现. 材料和方法回顾性分析34例经临床和病理证实的EBTB的CT表现.结果长段支气管管壁增厚和管腔狭窄31例,其中狭窄段管壁光滑14例、不规则狭窄17例,.28例可见肺内播散病灶,狭窄、阻塞支气管远端出现肺叶或肺段不张16例,实变5例. 21例可见肺门/纵隔淋巴结肿大.结论CT检查在EBTB诊断和鉴别诊断中具有重要临床价值. 相似文献
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支气管内膜结核的CT诊断 总被引:10,自引:2,他引:8
目的 探讨CT对支气管内膜结核的诊断价值。方法 回顾性分析 14例经纤支镜活检证实的支气管内膜结核的CT表现。结果 14例肺叶、段支气管起始或分支部狭窄 ,其中 6例锥形狭窄引起完全性肺不张并大量胸腔积液 ,8例管壁增厚 ,向心狭窄 3例 ,偏心狭窄 5例 ,伴息肉 3例。狭窄较局限 ,无肿块及反“S”征。不张或实变区有窄后扩张的支气管充气征。 9例伴肺内结核 ,占 64 .3 %。结论 CT对支气管内膜结核有重要诊断价值 ,能区别肿瘤性或非肿瘤性支气管狭窄。但早期仍需借助于纤支镜活检。 相似文献
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支气管内膜结核(EBTB)是肺结核的一种特殊类型,缺乏典型的临床症状,极易漏诊或误诊,常因延误治疗而出现较严重的并发症.多层螺旋CT(MSCT)结合三维重组技术可清晰直观地显示受累支气管的局部征象及肺部病变,是纤维支气管镜的有力补充.就EBTB的临床特征、病理分型、影像学表现及鉴别诊断等进行综述. 相似文献
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气道内结核病是气管、支气管黏膜的结核病变,大多与肺结核并发。由于结核杆菌侵袭气管、支气管黏膜及黏膜下层,部分患者可损害肌层及软骨,最终疤痕愈合导致气管、支气管狭窄。若未及时有效地治疗,将导致支气管不可逆性瘫痕狭窄或管壁的软化,严重者可导致肺不张。随着支气管镜及其腔内介入技术的发展,可弯曲支气管镜介导的高频电刀治疗已被广泛应用于临床。高频电凝将电能转化为热能.利用热作用对肉芽组织及干酪坏死进行电切和电凝,可有效地清除肉芽组织及干酪坏死,恢复气道通畅。本文报告132例气管内结核患者行支气管镜下腔内高频电刀电凝治疗,取得了良好效果。 相似文献
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支气管内膜结核的CT表现 总被引:13,自引:0,他引:13
目的 分析支气管内膜结核 (EBTB)的CT表现 ,提高对EBTB的认识。资料与方法 回顾分析 18例经纤维支气管镜、病理证实的EBTB的胸部CT表现 ,探讨支气管本身的异常以及肺实质、淋巴结和胸膜改变。结果 共 2 1处支气管受累 ,右肺多于左肺 ,累及下叶最多。支气管壁增厚 16处 ,管腔狭窄 13处 ,累及较长段者 (>3cm) 10处 ,管壁增厚、局部管腔扩大 5处。 5例继发肺不张 ,11例并存支气管播散灶。所有患者肺野内均可见陈旧性肺结核灶 ,8处病灶为活动性 ,15例并发胸膜病变。肺门纵隔淋巴结肿大 9例。结论 较长段的支气管壁中心性增厚为EBTB的主要表现 ,多数并存肺实质和胸膜病变 ,淋巴结环形强化为其特征 相似文献
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孙宝泉 《国外医学:临床放射学分册》1998,(5)
为了便于对中央气道结核活动性病变的管理,提高对中央气道结核活动性与纤维性病变CT表现的认识,作者对41例气管、主支气管结核病例的CT资料进行了回顾性研究。男14例,女27例,年龄17~63岁。依照支气管镜检所见及活检结果将病人分为两组:活动结核组30例,支气管镜检表现为活动性干酪化改变(干酪物质、溃疡或肉芽组织),或组织学表现为干酪性坏死、或结核菌培养阳性;纤维结核组11例,支气管镜检示纤维化,活检证实或结核 相似文献
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目的分析胸部X线及CT影像征象在支气管结核临床诊断中的价值和意义。方法收集本院经病理及电子支气管镜证实为支气管结核105例,对照其胸部X线与CT表现进行回顾性分析。结果105例患者中,胸部X线显示伴有肺内结核灶77例,气管狭窄、肺叶不张分别为51例和49例,未见异常表现17例。胸部CT扫描对气管狭窄及肺叶不张检出率明显提高,分别为72例和61例,且能观察到气管内壁情况及狭窄或阻塞后肺野情况,伴肺内结核灶79例,无异常改变只有8例。结论提高对支气管结核的影像学认识,能有效地提高临床诊断准确率。 相似文献
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目的分析支气管内膜结核的CT表现,探讨CT对支气管内膜结核的诊断价值。方法回顾性分析20例经纤支镜活检证实的支气管内膜结核的CT表现。结果20例支气管、叶支气管狭窄,11例锥形狭窄,9例管壁增厚,其中.向心性狭窄5例,偏心性狭窄4例,伴支气管扩张7例,钙化4例。6例继发肺不张,19例患者肺野内均可见不同性质肺结核灶,12例并发胸膜病变。肺门纵隔淋巴结肿大及钙化11例。结论CT是诊断支气管内膜结核的有效方法,其CT表现具有一定的特征性。 相似文献
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Multidetector CT virtual bronchoscopy to grade tracheobronchial stenosis 总被引:25,自引:0,他引:25
Hoppe H Walder B Sonnenschein M Vock P Dinkel HP 《AJR. American journal of roentgenology》2002,178(5):1195-1200
OBJECTIVE: The purpose of this study was to compare the efficacy of noninvasive multidetector CT (virtual bronchoscopic images, axial CT slices, coronal reformatted images, and sagittal reformatted images) in depicting and allowing accurate grading of tracheobronchial stenosis with that of flexible bronchoscopy. MATERIALS AND METHODS: Multidetector CT and flexible bronchoscopy were used to examine 200 bronchial sections obtained from 20 patients (15 patients with bronchial carcinoma and five without central airways disease). Multidetector CT was performed using the following parameters: collimation, 4 x 2 mm, pitch, 1.375; and reconstruction intervals, 2 mm. Postprocessing was performed using surface rendering and multiplanar reformatted images. CT images were independently interpreted by two radiologists. The tracheobronchial stenoses revealed on flexible bronchoscopy were graded by a pulmonologist. RESULTS: Virtual bronchoscopic findings, axial CT scans, and multiplanar reformatted images were highly accurate (98% accuracy for virtual bronchoscopic images, 96% for axial slices and coronal reformatted images, and 96.5% for sagittal reformatted images) in revealing tracheobronchial stenosis. In allowing accurate grading of tracheobronchial stenosis, images from virtual bronchoscopy correlated closely (r = 0.91) with those of flexible bronchoscopy. Because use of virtual bronchoscopic images reduced the overestimation of stenosis, these images allowed better assessment of stenosis than did axial CT slices (r = 0.84) or multiplanar reformatted images (r = 0.84) alone. CONCLUSION: Multidetector CT virtual bronchoscopy is a reliable noninvasive method that allows accurate grading of tracheobronchial stenosis. However, it should be combined with the interpretation of axial CT images and multiplanar reformatted images for evaluation of surrounding structures and optimal spatial orientation. 相似文献
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Photodynamic laser therapy is used in the palliation of advanced lung cancer. To minimize the complications of this form of therapy, physicians must evaluate correctly the extent of extraluminal disease. We undertook a study to compare CT and bronchoscopy in the evaluation of extent of disease before laser therapy in 20 patients with complete bronchial obstruction. The relative contribution of intraluminal and extraluminal tumor to the obstruction and its influence on response to therapy was assessed by using both techniques. Adequate response was defined as greater than or equal to 50% relief of the obstruction on bronchoscopy performed within 1 week of therapy and by any improvement of the postobstructive atelectasis and consolidation on follow-up chest radiographs. Nine patients had predominately intraluminal tumor on both CT and bronchoscopy before laser therapy. Eight of these had a bronchoscopic response and radiographic improvement after therapy. Ten patients had predominately extrinsic compression by tumor on CT. Of these, only two had a bronchoscopic response and none had radiographic improvement after treatment. The differences in bronchoscopic and radiographic response between the two groups were significant (p less than .01). In the 10 patients with predominately extraluminal tumor on CT, bronchoscopy agreed with CT in suggesting mainly extrinsic compression in five, but it incorrectly suggested mainly intraluminal tumor in the remaining five. In one patient with a left upper-lobe tumor, the relative intra- and extraluminal components could not be assessed on CT. We conclude that in complete bronchial obstruction, CT is superior to bronchoscopy in evaluating the extent of extrinsic compression by tumor. The presence of predominately extraluminal tumor compression on CT correlates with a poor response to laser therapy. 相似文献
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螺旋CT仿真支气管内窥镜成像方法及其临床应用 总被引:10,自引:2,他引:8
评价螺旋CT仿真支气管内窥镜(CTVB)临床应用价值。材料和方法对52例气管、支气管行螺旋CT(GE
HiSoeedAdvantageCT/i)扫描,将其数据传至AdvantageWindows3.1版本工作站,用NavigatorSmooth软件建成酷似纤维支
气管镜所见的CTVB图像,并与纤维支气管镜对照。其中4例与病理标本对照。结果CTVB能100%地观察到段以上支
气管和80%以上亚段支气管。27例中心型肺癌发现支气管狭窄23例,闭塞4例,肺癌术后支气管残端4例,气管狭窄2
例,右中间段支气管憩室1例。结论CTVB是一种新的无创性观察气管、支气管腔的方法,酷似纤维支气管镜所见,但在
观察支气管粘膜的表浅病变和获取组织学标本方面不能取代纤维支气管镜。 相似文献
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目的:分析支气管内膜结核(EBTB)的CT表现,以提高对EBTB的认识。方法:回顾分析了45例经纤支镜及病理证实的EBTB的胸部CT表现,探讨支气管本身的异常及肺实质、淋巴结以及胸膜的改变。结果:45例病人CT片上共显示92处支气管受累,包括右侧54处和左侧38处,其中28例显示两支以上的受累支气管,11例主、叶、段多支支气管同时受累。38例表现为支气管狭窄,狭窄程度为轻度20例、中度12例和重度6例。8例继发肺不张,30例并存支气管播散灶。所有患者肺野内均可见陈旧性结核灶,28例并发胸膜病变。肺门纵隔淋巴结肿大15例。结论:较长段的支气管管壁中心性增厚或主、叶、段多支支气管受累为EBTB的主要表现,多数并存肺实质和胸膜病变,引流区淋巴结可增大。 相似文献
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目的探讨多层螺旋CT后处理技术在小儿气道异物临床诊断中的应用价值。方法对我院39例疑似气道异物患儿行64排CT平扫后利用后处理技术重建图像资料,影像诊断为气道异物,并回访临床支气管镜下异物探查结果进行分析讨论。结果39例患儿中提供异物吸入史的为36例,37例支气管镜下异物探查取出术结果证实为阳性,准确率达95%,2例误诊,误诊率为5%;其中2例出现阻塞性肺炎,右侧支气管21例,左侧支气管15例,支气管分叉处1例。结论根据患儿有无吸入史,结合多层螺旋CT后处理技术后重建图像,对气道异物诊断、定位及临床治疗和预后提供了重要价值。 相似文献