支气管结核48例临床诊断分析

目的探讨提高支气管结核患者临床诊断水平的方法。方法回顾性分析我院2004年至2009年收治的48例支气管结核患者的临床资料。结果所有患者均有咳嗽、咳痰病史;X线检查有2例考虑为结核病,确诊率为4.17%(2/48);有30例患者行CT检查,12例确诊,确诊率为40%(12/30);48例行纤维支气管镜检,32例确诊,确诊率为66.67%(32/48);常规痰抗酸染色涂片有12例发现结核杆菌,阳性率为25%(12/48),结合支气管镜取材39例抗酸染色涂片阳性,阳性率为81.25%(39/48);确诊率为81.25%(39/48);病理检查38例确诊,确诊率为79.17%(38/48)。结论 X线、胸部CT、PPD检查、常规痰涂片检查及纤维支气管镜检查对支气管结核的诊断都存在盲区,但纤维支气管镜镜检联合镜下取材行痰抗酸杆菌培养及涂片检查或者联合病理学检查能大大提高诊断水平。

Analysis of the diagnosis of 48 cases of endobronchial tuberculosis

Objective To explore how to improve the diagnosis level of endobronchial tuberculosis.Methods The clinical datas of 48 cases of endobronchial tuberculosis were analysed retrospectively.Results All patients had cough,sputum history;X-ray examination confirmed two cases of tuberculosis,diagnosis rate was 4.17%(2/48);30 patients underwent CT examination,12 cases were diagnosed,diagnosis rate was 40%(12/30);48 cases had routine bronchoscopy examination,32 cases were diagnosed,diagnosis rate was 66.67%(32/48);conventional acid-fast stain of sputum smears in 12 patients found mycobacterium tuberculosis,the positive rate was 25%(12/48),drawn with 39 cases of bronchoscopic smear positive acid-fast stain positive rate was 81.25%(39/48);diagnosis rate was 81.25%(39/48);pathological examination confirmed 38 cases,diagnosis rate was 79.17%(38/48).Conclusion X ray,CT,PPD examination,routine sputum smear examination and fiberoptic bronchoscopy for the diagnosis of bronchial tuberculosis all had blind spots,but the fiberoptic bronchoscope microscopy combined acid-fast bacilli sputum smear or culture and joint pathology examination can improve the diagnostic level.