肺结核合并支气管结核97例临床分析

目的探讨肺结核合并支气管结核的临床特点。方法回顾性分析97例肺结核合并支气管结核临床资料。结果临床以咳嗽(82.5%)、咳痰(80.4%)、发热(45.4%)、不同程度咯血或血丝痰(23.7%)等为主要症状,胸部CT以肺不张或膨胀不全(44.2%)及浸润增殖性病灶(37.9%)为主要表现,并可见支气管狭窄阻塞、支气管扩张、支气管播散、支气管充气征、纵隔淋巴结增大、纵隔淋巴结钙化等表现,痰涂片或培养检查抗酸杆菌阳性率较高(63.9%),尤其在多叶段浸润增殖病灶患者中其阳性率高达83.3%。纤支镜检查以主支气管及叶支气管开口受累显著(64.8%),多气管支气管受累患者达81.4%,且多种支气管镜下表现类型并存,纤支镜刷检抗酸杆菌、组织活检阳性率分别为55.9%、69.4%。接受纤支镜介入治疗的患者仅有18例,其中6例支气管狭窄闭塞并肺不张患者行气管镜下支气管球囊扩张术治疗,5例支气管狭窄好转。结论肺结核合并支气管结核患者临床表现无特异性。胸部CT对观察支气管损伤及淋巴结病变能提供较大帮助。气管镜检查仍为其重要诊断手段,镜下可见多气管支气管受累,且镜下表现类型相互重叠。球囊扩张术可有效改善支气管狭窄。

The clinical anlaysis on 97 patients with active pulmonary tuberculosis associated endobronchial tuberculosis

Objective To explore the clinical features of the patients with active pulmonary tuberculosis associated endobronchial tuberculosis(EBTB). Methods Clinical data on 97 active pulmonary tuberculosis cases associated EBTB were analyzed retrospectively. Results Cough(82.5%),sputum production(80.4%),fever(45.4%) and the different degree of haemoptysis or blood stained sputum(23.7%) were the most common chief complaints.The most common roentgenographic findings were atelactasis/detelectasis(44.2%) and parenchymal infiltration and/or consolidation(37.9%),and bronchial stenosis or obstruction,bronchiectasis,bronchial dissemination,bronchial air sign,mediastinal lymphadenitis and lymph nodes calcification were also demonstrated in chest CT.Sputum smear/culture of acid-fast bacilli positive rate was 63.9%.It was 83.3% in the patients with muti-lobar/segmental parenchymal infiltration and/or consolidation of Chest CT.Bronchoscopic Results showed the lesions were more likely to be seen in the main and lobe bronchi.Multi-trachea/bronchi were involved(81.4%) and several subtype forms of bronchoscopic finding co-existed.The positive rate of bronchoscopic brushing smear for acid-fast baccili and biopsy was 55.9% and 69.4%,respectively.Only 18 patients received interventional bronchoscopic treatments.6 patients with bronchial stenosis/obstruction and atelactasis received the treatments of fiberoptic broncoscopic balloon dilation.As a result,stenosis was alleviated in 5 patients. Conclusions Symptoms were non-specific in the patients with active pulmonary tuberculosis associated EBTB.Chest CT was very useful in evaluating bronchial lesions such as stenosis or obstruction and the change of mediastinal lymph nodes. Bronchoscopy was still an important method to diagnose active pulmonary tuberculosis associated EBTB.Bronchoscopic findings showed that leision occurred on Multi-trachea/bronchi and overlapping subtype forms existed.Bronchial stenosis can be improved effectively by balloon dilation techniques.