支气管镜下酷似肺癌的肉芽增殖型气管支气管结核临床分析

目的：通过分析支气管镜下酷似肺癌的肉芽增殖型气管支气管结核（TBTB）的临床资料,提高对本病的诊断水平,避免误诊.方法：回顾性分析2011年10月至2012年10月期间温州医科大学附属第二医院收治的支气管镜下表现酷似肺癌的肉芽增殖型TBTB患者（共10例）的临床资料.结果：TBTB好发于中青年（占90％,9/10）,男女均可发病,临床症状以咳嗽、咳痰、咯血为主,痰菌阳性率低,发病部位以两肺上叶为主（占50％,7/14）,入院漏诊率（为50％）引及误诊率（为50％）高.支气管镜下均见典型新生物,如菜花状、结节状等,表面附有少许坏死物,合并相应气管、支气管狭窄者,与原发性支气管肺癌支气管镜下表现非常相似,影像学及支气管镜下表现与肺癌难以鉴别.经支气管镜检查刷检后涂片找抗酸杆菌阳性7例（7/10）,刷检后病理阳性7例（7/10）;经支气管镜下活检病理见典型结核样改变4例（4/7）;刷检病理及活检病理均阳性3例,刷检后涂片找抗酸杆菌及活检病理均阳性3例;三者均阳性2例.结论：TBTB临床表现缺乏特异性;肉茅增殖型TBTB支气管镜下表现酷似肺癌,结合支气管镜刷检抗酸染色、活检病理可提高其诊断率.

Clinical analysis of tracheobronchial tuberculosis with bronchoscopic performance looked like lung cancer

Objective： To improve the diagnosis and avoid misdiagnosis of tracheobronchial tuberculosis which bronchoscopic performance looked like lung cancer. Methods： The clinical data of 10 cases tracheobron- chial tuberculosis which bronchoscopic performance looked like lung cancer from the Second Affiliated Hospital of Wenzhou Medical University during October 2011 to October 2012 were collected, and the possible causes of misdiagnosis of lung cancer were analysed. Results： Tmcheobronchial tuberculosis often occured in middle-aged （90%, 9/10）. Main clinical symptoms were cough, sputum and haemoptysis. Sputum-positive rate was low. Le- sions locus of TBTB was mostly common on left upper lobar bronchus and fight upper lobar bronchus （50%, 7/14）. The rate of missed diagnosis and misdiagnosis were 50%. Bronchoscopy performance was neoplasm, which sur- face had some necrosis. Neoplasm could look like cauliflower, nodular or circular. Bronchus near the neoplasm often had stenosis, and was similar to bronchoscopic performance of primary lung cancer. So it made difficult to identify TBTB and primary lung cancer. There were 7 patients whose brush biopsy for acid-fast bacilli was posi- tive （7/10）. There were 7 patients whose brush pathology was positive （7/10）. There were 4 patients whose biopsy pathology was positive （4/7）. Three patients were positive in pathology of brush and biopsy. Three patients were positive in brush biopsy for acid-fast bacilli and biopsy pathology. Two patients were positive in pathology of brash and biopsy, and brash biopsy for acid-fast bacilli. Conclusion： Tracheobronchial tuberculosis is lack of specific clinical manifestations. When bronchoscopic performance can not be made a diagnosis of tracheobron- chial tuberculosis or lung cancer, diagnose relys on bacteriology and biopsy pathology.