纤维支气管镜诊断支气管结核98例分析

Clinical analysis of 98 cases with endobronchial tuberculosis

目的 探索支气管结核的确诊手段及临床特征。方法 分析 98例支气管结核患者的临床表现及纤支镜结果。结果 主要症状包括咳嗽 72例 (73% ) ,咳痰、咯血、气喘、胸痛、发热等。纤支镜示 :支气管刷检结核菌阳性率 85 .71% ,组织活检阳性率 6 9.2 3% ,其中 4 1.84 %以炎性浸润改变为主 ,2 2 .4 5 %以溃疡型改变为主 ,11.2 3%以增殖改变为主 ,2 4 .4 9%以瘢痕狭窄改变为主。结论 当有支气管结核临床表现及 X线表现特异性不强时 ,进行纤支镜检查。当病理、细菌学均不能明确诊断 ,可进行试验性抗结核治疗 。

Objective To explore the clinical features of endobronchial tuberculosis and the way of confirming the disease. Methods The clinical symptoms and fiberoptic bronchoscopic finding of 98 cases with endobronchial tuberculosis were analyzed. Results Main symptoms were as follows: cough expectoration with sputum, blood-stained sputum, breathlessness, chestache, and fever. Staining for acid-fast bacilli was 85.71% positive in bronchial washings and the diagnosis was confirmed by bronchoscopic biopsy specimens in 69.23%. The bronchoscopic results showed exduative lesions in 41.84% of the cases, ulcerative lesions in 22.45%, granulomatous in 11.23% and cicatricial lesions in 24.49%. Conclusion Bronchoscopic should be performed when there were clinical manifestations of endobronchial tuberculosis, but no typical chest X-ray features. When endobronchial tuberculosis could not be confirmed by pathology and bacteriology, anti-tuberculosis treatment should be repeatedly given until the diagnosis was confirmed by the follow-up observation.