支气管镜检查在气管和支气管结核诊断中的作用

目的探讨气管、支气管结核的临床特征及支气管镜检查在气管、支气管结核诊断中的作用。方法回顾性分析经Olympus电子或纤维支气管镜检查,后经病理学或抗酸染色证实为气管、支气管结核216例患者的临床资料及支气管镜检查资料。结果临床主要症状为刺激性干咳(72．7％)和间断性咯血(34．7％),缺乏典型的结核中毒表现。胸部影像学检查以肺内片状阴影(31．0％)和肺不张(24．1％)多见,影像学无明显异常者占16．7％。气管镜下表现为肉芽增殖型 (36．1％)、炎症浸润型(31．0％)、溃疡坏死型(24．1％)、瘢痕狭窄型(8．8％)。病变部位左肺 (56．2％)多于右肺(37．6％),左主支气管受累比例最大(26．9％),病变遍及所有叶、段支气管。 216例中经病理学诊断178例(82．4％),毛刷涂片抗酸染色细菌学诊断68例(31．5％)。结论气管、支气管结核缺乏特异性临床表现,误诊率较高,不重视支气管镜检查是误诊主要原因。支气管镜检查是气管、支气管结核最可靠和最准确的诊断方法。

Clinical application of fiberoptic bronchoscopy in diagnosis of trachea and bronchial tuberculosis

Objective To discuss the clinical features of trachea and bronchial tuberculosis and estimate the efficacy of the diagnosis of trachea and bronchial tuberculosis by fiberoptic bronchoscopy. Methods Clinical presentations and examination of fiberoptic bronchoscopy findings of 216 patients diagnosed by Olympus electric or fiberoptic bronchoscopy were retrospectively investigated. Results Male of the 216 patients were 95, female were 121, with 1.27 times higher incidence noted in female than in male subjects. An activator dry cough was the most complain in 72.7% , intermittent hemoptysis was in 34.7% , absenting of typical clinical poisoning symptoms of tuberculosis. Atelectasis and shape in lung were the most common chest roentgenographic presentations respectively in 31.0 % and 24.1 %. Chest roentgenographic presentations of 16.7% were normal. Bronchoscopic findings showed that main pathologic changes included 36.1% granulation, 31.0% mucosa inflammation, 24.1% ulceration (or necrosis) and 8. 8% cicatricial stenosis, left lung (56. 2%) was more often affected than right lung (37.6%), left bronchi (26.9% ) was in the first. The pathologic changes affected all of leaf, segment bronchi. One hundred and seventy-eight cases (82.4%) were diagnosed by bronchoscopic biopsy, 68 cases (31.5%) were diagnosed by bronchoscopic brushing examination for acid - fast bacillus. Conclusion The clinical features of trachea and bronchial tuberculosis are non - specific and easy to be misdiag-nosed. It is the main reason to be misdiagnosed that bronchial biopsy is neglected by clinical doctors. Bronchial biopsy should be the most reliable and accurate step to get the definite diagnosis.