纤维支气管镜检查慢性咳嗽63例

目的 探讨纤维支气管镜（纤支镜）在胸部X线检查正常的慢性咳嗽患者病因诊断中的作用.方法 回顾分析2003年7月-2006年7月胸部X线检查正常的63例慢性咳嗽患者纤支镜所见,镜下活检,刷检和肺泡灌洗术的病理及细菌学检查结果.结果 63例患者中,镜下观察到鼻息肉2例（3.2%）,鼻甲肥厚2例（3.2%）,鼻腔粘膜暗红、增厚3例（4.8%）,咽隐窝和咽后壁较多粘液附着3例（4.8%）,咽后壁滤泡增生呈鹅卵样观4例（6.3%）,鼻窦口见脓液、充血肿胀2例（3.2%）,声带结节1例（1.6%）,支气管粘膜轻度充血8例（12.7%）,局部支气管粘膜充血肿胀4例（6.3%）,局部管腔狭窄4例（6.3%）,新生物3例（4.8%）,小结节2例（3.2%）,局部见白色附着物1例（1.6%）,未见异常24例（38.1%）.找到抗酸杆菌4例（6.3%）,找到革兰阳性或革兰阴性细菌6例（9.5%）,其中细菌培养出菌株5株,找到真菌2例（3.2%）,找到癌细胞4例（6.3%）.结论 纤支镜对胸部X线检查正常的慢性咳嗽患者的病因诊断有重要意义,可提高诊断的准确性,减少误诊.

DIAGNOSIS OF 63 PATIENTS WITH CHRONIC COUGH BY FIBROBRONCHOSCOPY

Objective To investigate the efficacy of fibrobronchoscopy on the diagnosis of chronic cough with normal sign shown on chest X-ray. Methods Examination of fibrobronchoscopy findings, results of bronchoscopic biopsy, brushing examination and broncho-alveolar lavage for bacilli of 63 patients from July 2003~July 2006 were retrospectively investigated. Results Nasal polyp were seen in 2 cases(3.2%), turgescent turbinate in 2 cases(3.2%), congestion and edema of nasal mambrane in 3 cases(4.8%), pharyngorrhea in 3 cases(4.8%), follicular pharyngitic in 4 cases(6.3%), suppurative sinusitis in 2 cases(3.2%), vocal nodules in 1 case(1.6%), a little congestion of bronchial membrane in 8 cases(12.7%), local congestion and edema of bronchial membrane in 4 cases(6.3%), bronchial stenosis or obstraction in 4 cases(6.3%), neoplasm in 3 cases(4.8%), small nodules in 1 case(1.6%), and normal sign in 24 cases(38.1%). Acid-fast bacilli were found in 4 cases (9.3%), gram-positive or gram-negative bacteria in 6 cases(14.0%), fungi in 2 cases(4.7%), and carcinous cells in 3 cases(7.0%). Conclusion Fibrobronchoscopy is very important in the diagnosis of chronic cough. It is valuable in enhancing diagnosis accuracy and in reducing prevalence of misdiagnosis.