纤维支气管内窥镜对难治性肺炎和缓慢吸收性肺炎的诊断作用

The Diagnostic Value of Fiberoptic Bronchoscopic Examination in Pneumonia of Difficut to Cure and Slowly Assimilated

目的:探讨对难治性肺炎和缓慢吸收性肺炎的患者采用纤维支气管内窥镜(FOB)检查在诊断中应用价值。方法:9例肺炎患者在给予抗生素治疗2周后,病情和胸部CT未见好转,或病情有所好转而胸部CT病变吸收缓慢或未见好转。经FOB直接观察,同时采取BAL、PSB和TBLB,标本进行G染色、抗酸染色、细菌培养和病理检查。结果:9患者均能耐受FOB检查。8例得到确诊,其中肺癌2例,肺结核1例,肺结核合并支气管结石1例,先天性支气管狭窄1例,局部支气管外压狭窄但原因不能确定2例,广泛支气管粘膜肥厚、充血、水肿1例。BAL灌洗液培养出细菌4例。通过FOB相关检查,确诊率为88.9%,为临床诊治提供重要的依据。结论:采用FOB相关检查,对于肺炎缓慢吸收或难治性肺炎的病因学或病原学的确定有重要的意义。

Objective:To evaluate the role of fiberoptic bronchoscopy techniques in the etiological diagnosis of pneumonia which have been difficult to cure or slowly assimilated. Methods: Nine patients of pneumonia had been treated by antibiotics for more than two weeks, the clinical manifestation and chest CT of seven cases could not be mitigated, and the clinical feature of two cases had been mitigated while the chest CT realed infiltration assimilated under 50.0%. All the patients underwent fiberoptic bronchoscopy examination with protected specimen brush (PSB), bronchoalveolar lavage (BAL), trans-bronchosicpic lung biopsy (TBLB). Result: All the nine patients could be well tolerated the fiberoptic bronchoscopic examination. The diagnosis of eight cases were confirmed, among them 2 were lung cancer, 1 tuberculosis, 1 tuberculosis with broncholithiasis, 1 congenital brongchial stenosis, 2 bronchial stenosis acquired by exterior pressure, 1 bronchial mucosal edema and thickening of membranes. The bacteria had been discovered from BAL specimen cultures of four cases. The etiological diagnosis obtained from the techniques may guide the rational selection of therapy. Conclusions: fiberoptic bronchoscopy techniques can be used in the etiologic diagnosis of pneumonia hard to cure and slowly assimilated.