大气道结核延误诊断与影像检查的关系研究

Study of the Relationship between Delay in Diagnosis of Larger Airway Tuberculosis and the Imaging Methods

目的：分析大气道结核延误诊断的原因与影像检查的关系，并提出解决的可行办法。材料与方法：研究67例经病原学、纤支镜和／或手术病理证实为大气道结核的临床与各种影像检查的表现。结果：发现普通胸片漏诊率达100％，高kV胸片虽然能发现部分大气道狭窄但欠清晰，支气管体层、支气管造影及胸部CT均能较好地显示大气道受累所致的病变。结论：为及早提高大气道结核的发现率，除加强对本病的认识及警惕外，强调凡有顽固性刺激性咳嗽和／或气道梗阻症状者均应作进一步检查。支气管体层检查是发现大气道结核可靠而又廉价的方法，可作为照胸片之后的首选项目，若能加作胸部CT进行综合诊断，效果更佳。

Objective: To analyze the reason of delay in diagnosis of tracheal tuberculosis, to study its relation with imaging method, and to seeka way to avoid the misdiagnosis. Materials and Methods:The clinical data and imaging findings of 67 cases with pathologically-proved tracheal orbronchial tuberculosis were analyzed. Results:With conventional X-ray film, the miss diagnosis rate was 100 %. Even with high-kV radiography, on-ly narrowed larger airway could be demonstrated in just a few cases. However, in all cases larger airway involvement could be well observed with to-mography, bronchography or chest CT. Conclusion: Tracheal and bronchial tomography is an economic and reliable exam for detecting larger airwaytuberculosis, and should be served as frst choice after taking conventional chest film. CT will provide more useful information.