支气管结核介入诊治的认识和思考

Endobronchial Tuberculosis:the Interventional Diagnosis and Therapy by Bronchoscope

支气管结核(EBTB)的介入诊断和治疗有了长足的进展,但也面临着诸多的问题,有必要加深认识和思考。EBTB的支气管镜下分型目前分为五型,即炎症浸润型(Ⅰ型)、溃疡坏死型(Ⅱ型)、肉芽增殖型(Ⅲ型)、疤痕狭窄型(Ⅳ型)、管壁软化型(Ⅴ型),建议在原来EBTB"五型"的基础上将结核性支气管瘘从第Ⅱ型中分离出来成为单独的一型即Ⅵ型。在支气管结核的治疗中,应根据不同的类型,采用包括高频电刀、冷冻、氩气刀、激光、支架置入、球囊扩张以及黏膜下穿刺注射抗结核药物等综合介入技术进行治疗。

There are so many challenge and difficulties for endobronchial Tuberculosis（EBTB）. In China, the EBTB is clas sified into five types, of which are inflammatory hyperaemia（ Ⅰ ）, cheesy necrosis and mucosal ulceration（ Ⅱ ）, hyperplastic polyp（Ⅲ ）, bronchostenosis（ Ⅳ ）, inteneration of bronchial wall（ Ⅴ ）. We suggested that tuberculosis fistula may peeled off the type Ⅱ and become the independent type Ⅵ. According to distinct types, various combination of interventional technology can be used, including electrocautery, cyrotherapy, argen plasma coagulation, laser, tracheobronchial stent implantation, balloon dilatation, puncturing and injecting anti--tuberculosis remedy under sub--mucous.