支气管镜及支气管肺泡灌洗诊断结核病和霉菌感染

本文评价支气管镜检查及支气管肺泡灌洗(BAL)在结核病和霉菌感染诊断中的作用。病人和方法最后确诊为结核病或霉菌感染且做过支气管镜检查者91例,其中结核病50例.霉菌感染41例。将患者分为两组,一组为诊断不明需行支气管镜检查确诊者(结核病30例,霉菌感染41例),另一组为诊断明确因研究需要行支气管镜检查者(结核病20例);对照组35例,为吸烟成人患者,行支气管镜检查以明确局限性肺部病变。所有患者均行支气管冲洗和 BAL,支气管冲洗液和 BAL 液被送检作结核     

支气管结核的介入治疗现状

支气管结核为发生在气管或支气管部位的结核病,由于缺乏特异性,X线表现可正常,极易发生误诊、漏诊。支气管镜检查是诊断支气管结核最敏感、最特异的方法,经支气管镜直视改变、刷检、灌洗及活检可以显著提高确诊率。     

电子支气管镜检查在支气管内膜结核诊断中的应用

支气管内膜结核（endobronchial tuberculosis,EBTB）是发生在气管、支气管粘膜或粘膜下层的结核病。影像学,痰抗酸杆菌检测等检查无特异性,电子支气管镜可以直视下观察气管、支气管粘膜的病变,并在病变部位进行活检和刷检,提高了支气管内膜结核的诊断阳性率。我们回顾分析2005年1月～2008年12月我院经电子支气管镜检查确诊的68例支气管内膜结核患者的临床资料,分析如下。     

支气管镜诊治肺不张150例临床分析

目的 本研究旨在探讨肺不张不同年龄组病因特点及支气管镜下特征.方法 经胸部影像学检查诊断肺不张的患者,行支气管镜检查,结合钳取活检、刷检、肺泡灌洗吸引、细胞学等检查进行分析.结果 150例肺不张患者经支气管镜检查,病因诊断率达（98.0%）;肺不张常见原因包括肿瘤（38.0%）,炎症（26.7%）,粉尘（22.0%）,结核（6.0%）,外伤（3.3%）;分析得出老年组肺不张以肺癌、炎症、粉尘为主;中年组肺不张以肺癌、炎症为主;青年组肺不张以结核、炎症多见.结论 支气管镜检查对肺不张具有直接观察、病因诊断及治疗的重要作用.     

纤维支气管镜检查对支气管结核诊断的临床分析

目的为提高支气管结核的诊断水平。方法对37例经纤维支气管镜检查确诊的支气管结核患者的临床分析。结果纤维支气管镜下显示,充血炎症型占51.3%,溃疡、干酪坏死型占37.8%,肉芽增殖型占18.9%,瘢痕狭窄型占24.3%。纤维支气管镜刷检阳性率89.2%,活检阳性率43.2%。结论纤维支气管镜检查对支气管结核的诊断具有重要的临床价值。     

经电子支气管镜活检和／或刷检诊断肺癌的临床研究

目的探讨经支气管镜单纯活检同活检加刷检对肺癌的诊断价值。方法患者在常规局麻下行电子支气管镜检查,钳取组织标本或（和）作毛刷涂片行细胞学检查。结果钳检阳性率高于刷检阳性率,但单纯活检阳性率与活检＋刷检阳性率比较无统计学差异,（P〉0.05）。结论经电子支气管镜活检＋刷检与单纯活检相比,不能提高肺癌诊断的阳性率,且相关并发症、医疗费用明显上升。     

纤维支气管镜下183例肺不张病因诊断及治疗

目的探讨纤维支气管镜检查在肺不张的病因诊断及治疗中的应用价值。方法经X线、CT检查诊断为肺不张183例患者进行纤支镜检查,镜下活检,刷检,灌洗等。结果年轻患者肺不张病因以炎症、结核为主,中老年患者肺不张以恶性肿瘤为主。结论纤维支气管镜检查有助明确肺不张的病因诊断,对指导治疗有重要价值。     

支气管镜对右肺中叶综合征诊治价值

目的 探讨支气管镜检查对右肺中叶综合征诊治价值.方法 对影像学诊断为右肺中叶综合征的100例患者行电子支气管检查,并在镜下进行刷检、活检、灌洗.结果 右肺中叶综合征的病因及表现各异,其中炎症60例,肺癌20例,结核13例,异物3例,痰栓2例,原因不明2例.从而制定相应的治疗方案,并对45例行支气管镜下治疗,取得较好疗效.结论 右肺中叶综合征临床常见,病因复杂多样,采用支气管镜检查对明确病因、指导临床诊治有重要价值.     

纤维支气管镜对支气管内膜结核诊断的价值

目的探讨纤维支气管镜对支气管内膜结核的诊断价值。方法分析经支气管镜检查确诊的30例支气管内膜结核的临床表现和镜下特点。结果镜下粘膜肥厚狭窄13例（43.3％）、充血水肿7例（23.3％）、糜烂溃疡5例（16.7％）、疤痕狭窄5例（16.7％）。活检阳性率23.3％，刷检阳性率60.0％，（刷检＋活检）阳性率为70.0％。结论支气管镜对支气管内膜结核有重要诊断价值。     

支气管镜检对不明原因胸闷患者的诊断价值研究

目的利用电子支气管镜对不明原因胸闷患者进行检查。方法收集我院呼吸内科门诊不明原因胸闷患者78例,电子支气管镜检查,并行支气管刷检、活检、支气管肺泡灌洗液检查。结果支气管镜检查显示:支气管肺癌19例(24.4%),炎性改变17例(21.8%),支气管结核11例(14.1%),痰栓所致肺不张8例(10.3%),支气管异物6例(7.7%),支气管狭窄2例(2.6%),支气管正常改变15例(19.2%)。灌洗液发现可疑肿瘤细胞10例(12.8%),灌洗培养阳性12例(15.4%);黏膜刷检11人次发现抗酸杆菌(14.1%),发现可疑肿瘤细胞6例(7.7%);肿物活检:结核结节7例(9.0%),鳞癌14例(17.9%)腺癌5例(6.4%)。结论电子支气管镜检查及支气管黏膜刷检、肺泡灌洗液、活检,对不明原因胸闷患者病因诊断有重要意义。     

Correlation between bronchoscopically visible aspects and histopathologic results in patients with suspected lung cancer

The aim of our study was to determine correlation between bronchoscopically visible lesions and histopathologic classification and whether cytology and histopathology can complement each other in diagnosis of pulmonary neoplasm. Fibroptic flexible bronchoscopy was performed in 208 patients who where suspected of having lung cancer--abnormal chest x-ray or hemoptysis. Material for histopathologic examination was obtained from bronchial brushings, bronchial forceps biopsy and bronchial washings. Positive results were classified as non--small cell or small cell carcinomas. All patients were questioned about smoking history. In 165 patients there were visible signs of neoplasm in bronchoscopic examination: tumor, necrosis, infiltration, compression. Histopathology was positive in 90 cases:small cell carcinoma 32%, non-small cell carcinoma 68%. In 23 cases material for histopathologic examination was obtained from both bronchial brushings and foceps biopsies: results were compatible in 78%. Bronchial brushings identified neoplasm in three additional cases. In analysed group of 208 patients cancer cells were found in 43%. Examination of bronchial brushings coplements forceps biopsy in diagnosing and typing lung neoplasms and could be performed more frequently in patients undergoing fiberoptic bronchoscopy.     

Extension of pulmonary tuberculosis after fibreoptic bronchoscopy

Two cases are described in which the diagnosis of pulmonary tuberculosis was suspected on both clinical and radiological grounds. Sputum smear and culture were negative for acid fast bacilli. Consequently a bronchoscopy and bronchial washings from the affected lobe were undertaken. While this procedure achieved a positive diagnosis of pulmonary tuberculosis, it also resulted in a significant extension of the disease.     

Do brushings taken during bronchoscopy for suspected primary lung cancer increase diagnostic yield? An audit of real-world clinical practice

We reviewed clinical records to determine whether the use of bronchial brushings improved diagnostic yield in a setting where bronchoscopy for suspected primary lung cancer is routinely guided by prior chest computed tomography but endobronchial ultrasound-guided sampling is unavailable. For 29% of cases who had brushings and at least one other test taken (bronchial biopsies or washings), the histological diagnosis was made solely on the basis of samples obtained by brushings.     

Diagnostic usefulness of transbronchial aspiration and bronchial lavage for pulmonary tuberculosis

Fiberoptic bronchoscopy is a well established methods as a useful tool in the diagnosis of pulmonary tuberculosis with smear negative cases. In order to get the early and definite diagnosis of pulmonary tuberculosis, we performed transbronchial aspiration and bronchial lavage by a fiberoptic bronchoscope in 97 patients. All patients (1) were clinically suspected of having active tuberculosis; (2) showed abnormal chest roentgenogram suggesting tuberculosis; (3) showed negative sputum smears of acid-fast bacilli, or had no sputum. The results of the study were summarized as follows: 1) Final diagnosis of study subjects were 90 patients of active pulmonary tuberculosis, and 7 patients of pulmonary atypical mycobacteriosis. 2) Sputum culture of acid-fast bacilli was positive in 22 out of 90 patients with active pulmonary tuberculosis. 3) Smear and culture examination of acid-fast bacilli of transbronchial aspirates were positive in 9 and 28, respectively out of 90 patients. 4) Smear and culture examination of acid-fast bacilli of bronchial lavage were positive in 12 and 39, respectively out of 90 patients. 5) A rapid and definite diagnosis was made in 16 out of 90 patients by transbronchial aspirates or bronchial lavage. 6) Atypical mycobacteria were detected in 7 out of 97 patients by transbronchial aspirates or bronchial lavage. 7) There were no serious complications such as pneumonia and exacerbation of pulmonary tuberculosis. These results suggested that transbronchial aspiration and bronchial lavage were useful procedures for rapid and definite diagnosis of pulmonary tuberculosis.     

Diagnostic value of bronchoscopy in diagnosis of pulmonary tuberculosis: bronchial aspirate, bronchial washing and transbronchial lung biopsy

The diagnosis of pulmonary tuberculosis is confirmed by the detection of Mycobacterium tuberculosis in sputum. Bronchoscopy has been used for diagnosis of various pulmonary diseases. The value of bronchoscopy such as bronchial aspirate, bronchial washing and transbronchial lung biopsy in diagnosis of pulmonary tuberculosis was evaluated, and the results were as follows: 1) One hundred ninety cases were investigated bronchoscopically due to suspicion of pulmonary tuberculosis with sputum negative smear and 92 cases were confirmed to be pulmonary tuberculosis. 2) Out of 91 cases examined by bronchial aspirate and 46 cases by bronchial washing, smear positivity was 20.9% and 23.9% and culture positivity was 58.2% and 84.8%, respectively. Transbronchial lung biopsy showed positive findings of tuberculosis in 75.8% out of 33 specimens. 3) Out of 88 sputa taken before bronchoscopy and 50 sputa after bronchoscopy, smear positivity was 0% and 12%, and culture positivity was 54.5% and 40% respectively. Gastric lavage culture positivity was 29.4% in 17 cases examined. 4) Diagnosis of tuberculosis was made rapidly in 28 cases (30.4%) by smear positive results of bronchial aspirate, bronchial washing and sputa after bronchoscopy, and relatively rapidly in 20 cases (21.7%) by transbronchial lung biopsy.     

The value of flexible bronchoscopy in childhood pulmonary tuberculosis

The value of 121 flexible bronchoscopy (FB) procedures was evaluated in 54 children, aged three months to 14 years, suspected of having pulmonary tuberculosis. Specimens from FB were culture-positive for Mycobacterium tuberculosis in seven of the 13 bacteriologically confirmed cases. Bronchial abnormalities consistent with the diagnosis were found in 31 of 54 cases. Separate or coexistent findings at initial FB included airway compression (20 cases), granulation tissue (ten cases), and obstructive caseum (four cases). Chest roentgenograms underestimated bronchial involvement in 14 children. Further FB monitoring documented disease evolution. The FB was important in the management of patients, as it (1) guided the use of prednisone therapy, especially in the children with a chest roentgenogram not suggestive of bronchial involvement; (2) indicated a need for resection of granulation tissue by rigid bronchoscopy (three cases); and (3) guided the surgical decision (two children with persistent bronchial obstruction). Thus, FB is a safe and valuable procedure in the management of childhood pulmonary tuberculosis.     

Bronchoscopy and transbronchial biopsy in evaluation of patients with suspected active tuberculosis

To assess the value of fiberoptic bronchoscopy and transbronchial biopsy for evaluating patients suspected of having tuberculosis, we reviewed the records of 56 patients (1974–1980). All patients (1) were clinically suspected of having active tuberculosis; (2) had an abnormality on chest roentgenogram consistent with tuberculosis; (3) had an absence of acid-fast bacilli on three sputum smears or an inability to produce sputum; (4) had undergone fiberoptic bronchoscopy and transbronchial biopsy. The evaluations included fiberoptic bronchoscopy with collection of bronchial washings and brushings, and transbronchial biopsy and postbronchoscopy sputum specimens. Thirteen patients subsequently underwent percutaneous needle aspiration and one underwent thoracotomy.

Evaluations were diagnostic in 29 of the 56 patients (52 percent). Diagnoses were mycobacterial infection in 22 (39 percent) and other disease processes in seven (13 percent). Fiberoptic bronchoscopy and transbronchial biopsy provided a diagnosis when sputum cultures obtained before bronchoscopy were negative for Mycobacteria in 11 (20 percent) patients. Immediate diagnoses were made from microscopic specimens obtained from 11 of 23 (48 percent) fiberoptic bronchoscopy and transbronchial biopsy procedures on patients with previously undiagnosed mycobacterial infection. Transbronchial biopsy had the best yield for a microscopic diagnosis. On culture, bronchoscopy specimens had a lower yield (10 of 23 or 44 percent) than sputum specimens obtained before bronchoscopy (14 of 21 or 67 percent) probably due to the inhibition of mycobacterial growth by tetracaine. Of the patients in whom evaluation proved nondiagnostic, 17 of 27 were lost to follow-up; therefore, a definitive statement regarding the number of false negative evaluations is not possible.

Fiberoptic bronchoscopy and transbronchial biopsy (FFB/TBB) is a useful procedure in evaluating patients with negative smears who are clinically suspected of having tuberculosis. It can improve the ability to document active tuberculosis, provide a sensitive means of making an immediate diagnosis, and uncover other disease processes presenting like tuberculosis.     

纤维支气管镜检查对老年人不典型肺结核的诊断价值

目的评价支气管镜术对老年人不典型肺结核的诊断价值。方法对５１例老年不典型肺结核患者在纤维支气管镜直视下获取标本进行病理学和细菌学检查。结果刷检直接涂片和支气管肺泡灌洗液经离心浓集涂片同时找到抗酸杆菌２７例（５２．９％）；活检经病理学检查呈结核病变８例（１５．８％）；刷检７例（１３．７％）、支气管肺泡灌洗液４例（７．８％）、吸引物３例（５．９％）及术后痰检２例（３．９％）分别找到抗酸杆菌。结论纤维支气管镜检查对老年人不典型肺结核的诊断具有重要价值     

Diagnostic value of bronchoalveolar lavage in suspected pulmonary tuberculosis

Of 222 patients suspected of having pulmonary tuberculosis (PT), studied during a one-year period, we performed fiberoptic bronchoscopy together with bronchoalveolar lavage (BAL), bronchial washing and postbronchoscopy sputum smears and L?wenstein cultures in 20 patients. Bronchoalveolar lavage proved to be the most effective method leading to diagnosis in 17 of 20 cases. Diagnosis was obtained in 11 of 20 cases using bronchial washing and postbronchoscopy sputum. The results of this study suggest that bronchoscopy may be required in selected cases for the diagnosis of PT. However, it should be accompanied by BAL, bronchial washings and postbronchoscopy sputum smears. Indications for bronchoscopy as a diagnostic tool for PT may include: (a) patients suspected of having PT with negative smears and in whom treatment must be started due to clinical status; (b) suspicion of associated neoplasia; (c) selected patients with negative L?wenstein cultures; (d) lack of material being obtained by simpler methods.     

Bronchoscopic diagnosis of endoscopically visible lung malignancies: should cytological examinations be carried out routinely?

Background: The aim of this study was to determine the diagnostic yield of flexible bronchoscopy in endoscopically visible malignancies and to evaluate whether cytological examination, including bronchial washings and brushings, increase the diagnostic yield compared with bronchial biopsy alone. Methods: We reviewed a series of bronchoscopies over a period of 7.5 years in which an endoscopically visible tumour was identified and which had a definite cytological or histological diagnosis of pulmonary malignancy obtained by bronchoscopy or any other examination. Results: The criteria were met by 174 bronchoscopies. In 155 bronchoscopies all specimens including bronchial washings, brushings and biopsies were obtained; the overall diagnostic yield was 88%. This compared with a diagnostic yield of 77% for biopsies only (P < 0.001). The individual diagnostic yields for biopsies, brushings and washings were 77, 50 and 38%, respectively. The overall diagnostic yield of cytology was 61%, providing a diagnosis in 95 patients. Of 11 repeat bronchoscopies after an initial non‐diagnostic bronchoscopy, 9 were diagnostic. Conclusion: The tumour detection rate with flexible bronchoscopy in endoscopically visible lung malignancies is high. Cytology‐based sampling techniques by means of bronchial washings and brushings significantly increase the overall diagnostic yield compared with forceps biopsy only. Repeat bronchoscopies after an initial non‐diagnostic bronchoscopy have a relatively high diagnostic yield and should therefore be considered in all patients with endoscopically visible tumour.