支气管镜检查对肺结核的诊断价值

目的:探讨支气管镜检查对肺结核的诊断价值。方法:回顾性分析经支气管镜检查确诊的68例肺结核患者的临床资料。结果:168例患者被确诊以前52例误诊,占76.5%;16例漏诊,占23.5%。268例中有31例并发支气管内膜异常改变,占45.6%;病变分布与胸部影像学显示的叶段基本符合。3支气管镜检查可直接发现病灶并进行取材。4对镜下无异常改变患者应用影像学定位或在X线透视下可进行病灶盲检和刷检取材。5经活检病理诊断为肺结核44例,占64.7%;经刷检细菌学检查诊断为肺结核24例,占35.3%。结论:支气管镜检查在确诊肺结核,减少误诊率方面有重要的临床意义。建议对临床可疑肺结核,但痰菌阴性;咯血原因不明者;肺不张原因不明者;诊断为肺炎,抗感染治疗效果不佳者及胸部影像学检查酷似肺癌者尽早进行支气管镜检查。

Diagnostic value of fiberoptic bronchoscopy in lung tuberculosis

Objective: To investigate the diagnosis value of fiberoptic bronchoscopy lung tuberculosis. Methods: Clinical presentations of 68 definite lung tuberculosis patients diagnosed by fiberoptic bronchoscopy were restrospectively investigated. Results: ①52 cases (76.5%) were misdiagnosed before definite diagnosis, 16 cases(23.5%) were missed diagnosis. ② 31 cases of the 68 patients had abnormality changes of bronchial endometrium(45.6%); the pathologic changes roughly accorded with the chest roentgenographic presentations showed, which affected the leaf or segment bronchi. ③Fiberoptic bronchoscopy could directly find pathological changes and drew the materials from the bronchial endometrium.④Bronchoscopic blind biopsy and bronchoscopic brushing examination should be taken on the patients whose fiberoptic bronchoscopy findings were normal by chest roentgenographic localization or seeing through radial line. ⑤44 cases (64.7%) were diagnosed by bronchoscopic biopsy, 24 cases (35.3%) were diagnosed by bronchoscopic brushing examination for acid-fast bacillus. Conclusion: Bronchoscopic biopsy has important clinical diagnosis value on definite diagnosis and reducing misdiagnosis rate. Clinical doctors should take fiberoptic bronchoscopy as soon as possible in the cases as follows: Clinical features are doubtful lung tuberculosis but examination for acid-fast bacillus is negative. Hemoptysis due to unknown reasons. Atelectasis due to unknown reasons. The disease is diagnosed as pheumonia, but antiinfection treatment is not satisfactory. Chest roentgenographic presentations look like thase lung cancer.