支气管结核误诊92 例临床特征及内镜价值分析

目的探讨支气管结核（TBTB）的误诊原因、临床特点及支气管镜的诊断价值。方法对2006 年1 月- 2012 年1 月我科经电子支气管镜检查确诊的92 例误诊为其他疾病的TBTB 患者的临床资料进行回顾性分析。支气管镜对病变部位重点观察，并行活检、刷检及灌洗，影像表现与镜检结果对比观察。结果临床症状及化验检查缺乏特异性、胸片表现无典型性，胸部CT 支气管狭窄45 例（48.9%）、支气管阻塞6 例（6.5%）、支气管未见异常41 例（44.6%）。支气管镜下表现为炎症浸润型28 例（30.4%）、溃疡坏死型14 例（15.2%）、肉芽增殖型35 例（38.0%）、瘢痕狭窄型15 例（16.3%）；镜下活检病理确诊56 例（60.9%），镜下刷检涂片抗酸杆菌检查阳性32 例（34.8%），镜下吸引的分泌物或灌洗液抗酸杆菌检查阳性39 例（42.4%）、结核菌培养阳性75 例（81.5%）。结论支气管镜检查直视局部病变并予刷检、灌洗、活检是支气管结核最敏感、最特异的诊断方法，在预防TBTB 误诊方面有很大临床价值。

Clinical characteristics of 92 misdiagnosis cases of tracheobronchial tuberculosis and the clinic value of endoscope

Objective To investigate the reasons of tracheobronchial tuberculosis misdiagnosis and its clinical charac⁃ teristics as well as the diagnostic value of bronchoscope. Methods Clinical data of 92 cases of misdiagnosis of tracheobron⁃ chial tuberculosis by electronic bronchoscopy in our department from January 2006 to January 2012 were analyzed retrospec⁃ tively. Bronchoscopy, endoscopic biopsy, brushing, lavage and radiological images were all compared. Results Clinical symptoms and laboratory tests showed no specificity in diagnostic value; Chest X-ray was not typical. Bronchial stenosis was seen in 45 cases（48.9%）and bronchial obstruction was seen in 6 cases（6.5%）as shown in chest CT while no abnormality in the bronchus was seen in 41 cases（44.6%）. Bronchoscopy revealed 28 cases (30.4%) of inflammatory infiltration, 14 cas⁃ es (15.2%) of necrotizing ulceration, 35 cases (38.0%) of granulation hyperplasia and 15 cases (16.3%) of Scar stricture. En⁃ doscopic biopsy confirmed 56 cases (60.9%), while bronchoscopic brushing and examination of acid-fast bacillus approved 32 cases (34.8%). Then, bronchoscopic lavage of acid-fast bacillus verified 39 cases (42.4%). Lastly, tuberculosis bacterium culture ascertained 75 cases (81.5%). Conclusion Bronchoscopy of local lesion with brush, lavage and biopsy is the most sensitive and specific diagnostic method to diagnose tracheobronchial tuberculosis. It has great clinical value in preventing tracheobronchial tuberculosis misdiagnosis.