经纤支镜诊断菌阴肺下野结核60例及其误诊分析

Analysis on the reasons for misdiagnosis of 60 bacteriological negative tuberculosis cases confirmed by fibrebroachoscope of which are at lower part lung diagnosed using

目的 探讨纤维支气管镜检查在菌阴肺下野结核中的诊断价值及其误诊中的临床意义。方法 对 6 0例曾经被误诊 ,后经纤支镜检查确诊的肺下野结核的临床资料进行回顾性分析。结果 6 0例患者纤支镜下表现 :中、下叶支气管粘膜慢性炎症最多见 ,分别为 2 5例 (4 1.7% )和 2 0例(33.3% ) ,其次为管口狭窄 7例 (11.7% )。四种方法联合检出的 6 0例肺结核中 ,单纯刷检抗酸杆菌阳性 37例 (6 1.7% ) ;刷检 +支气管肺泡灌洗 (BAL)阳性 4 6例 (76 .7% ) ;BAL +镜检后痰检 +组织活检诊断肺结核 5 2例 (86 .7% )。结论 纤支镜检查能提高菌阴肺下野结核的诊断率 ,刷检、灌洗、组织活检及镜查后痰检可互相补充以提高诊断的阳性率 。

Objective To determine the diagnostic value of fibrebronchoscope on diagnosis bacteriological negative tuberculosis at lower part lung.Methods Retrospective analysis on the clinical information of 60 bacteriological negative tuberculosis cases confirmed by fibrebronchoscope who were misdiagnosed.Results Most of the cases suffered with catarrh at middle and lower part of bronchuswhich was 25 cases (41.7%) and 20 cases (33.3%) respectively.7 cases suffered with nozzle stricture (11.7%).37 cases (61.7%) with positive bacteriological result confirmed by merely brush examining.46 cases (76.7%) with positive result through brush examining and bronchus alveolus lavage.Fifty-two cases were diagnosed as tuberculosis through BAL and phlegm test after fibrebronchoscope and tissue live test.Sixty cases were diagnosed as tuberculosis by combination of the 4 mehtods (100%).Conclusion Fibrebronchoscope could improve the accurate diagnosis rate of tuberculosis at lower part of lung.Brush examining,bronchus alveolus lavage (BAL),tissue live test and phlegm test after fibrebronchoscope are supplementary for improving the diagnosis rate and avoiding misdiagnose.