气管、支气管内膜结核HRCT价值及临床意义

目的 :探讨HRCT对气管、支气管内膜结核的诊断价值及临床意义。方法 :对 3 2例诊断明确的住院患者行胸部HRCT扫描 ,结合纤维支气管镜检查情况 ,重点观察病变气道内壁及管腔的形态变化以及其病变远侧肺实质的病变情况。结果 :气管、支气管壁病变检出率为 73 .92 % ,其中管壁轻度增厚 5 4.3 5 % ,明显增厚 19.5 7% ;气道管腔形态改变检出率为 67.3 9% ,其中管腔狭窄 <5 0 % 41.3 0 % ,>5 0 % 19.5 7% ,管腔闭塞 6.5 2 %。同时观察到气管、支气管周围及纵隔淋巴结肿大 7例 ,病变支气管远侧管腔内粘液栓 12例 ,管腔局限性扩张 5例 ,小叶性肺气肿 18例 ,肺不张 2例 ,肺内结核病灶 3 9例。结论 :HRCT作为无创性检查 ,在观察气道病变的部位和范围、气道病变与肺内病变的关系、危重患者纤维支气管镜检查前的定位准备及估计预后均有重要的临床意义。

Value of HRCT for the diagnosis of endotracheal and endobronchial tuberculosis

Objective:To investigate HRCT findings of tracheobronchial tuberculosis and clinical significance of HRCT.Methods:HRCT features of 32 cases with tracheobronchial tuberculosis were analysed.The changes of the bronchial wall and lumen as well as the pathological changes in the lungs were observed.Results:The detectability of the changes in the wall of tracheobronchial tree was 73.91%,which included 54.35% of slight thickening of the wall and 19.57% of obvious thickening.The detectibility of the changes in the lumen was 67.39%,which included 60.87% of the narrowing and 6.52% of obliteration.Meanwhile the enlarged lymph node in mediastinum was observed in 7 cases,mucus embolus in the tracheobronchial tree in 12,localized dilatation in 5,lobular emphysema in 18 and tuberculous foci in the lung in 39. Conclusion :HRCT may play an important role in detecting the pathological changes of trachea and bronchi,as well as localization of the lesion before the fiberoptic bronchoscopy and estimation of the prognosis of the patients.