支气管镜检查对避免支气管内膜结核误诊的意义

The Significance of Bronchoscopy in Prevention of Misdiagnosis of Endobronchial Tuberculosis

目的探讨支气管内膜结核(endobronchical tuberculosis,EBTB)的误诊原因,提高早期诊断水平。方法回顾性分析我院24例EBTB的临床资料。结果本组临床表现以刺激性干咳为主,伴胸闷、喘息、发热、痰中带血等。X线胸片异常16例,无一例考虑EBTB;CT检查发现异常19例。误诊为支气管炎11例,支气管哮喘8例,肺炎4例,肺癌1例。误诊时间平均5个月。本组均经纤维支气管镜检查确诊EBTB,予正规抗结核及病变局部化疗,23例病情缓解,1例择期手术治疗。结论对于慢性刺激性咳嗽、活动后气短、咯血者,即使胸部影像学检查、痰涂片找结核菌检查无明显异常,也应考虑到EBTB,尽早行纤维支气管镜检查以确诊。

Objective To explore the misdiagnosis cause of endobronchial tuberculosis （EBTB） and to improve the level of early diagnosis. Methods The clinical data of 24 patients with EBTB were retrospectively analyzed. Results The main clinical manifestation in this group was amyctic dry cough, associated with dyspnea, gasping, fever, and bloody sputurru Chest x-ray imaging showed abnormality in 16 patients, and no one was considered as EBTB; CT examination showed abnor- mality in 19 patients. 11 patients were misdiagnosed as bronchitis, 8 as bronchial asthma, 4 as pneumonia, and 1 as lung canc- er. The mean misdiagnosis time was 5 months, and all the patients were diagnosed as EBTB under bronchoscopy. After under- going routine antiuberculotic treatment and chemotherapy in diseased region, 23 patients were relieved of symptoms, and 1 received selective operation. Conclusion In spite of with normal chest imaging and sputum examination results, possibility of EBTB should be taken into account when present amyctic dry cough, short breath after activities and hemoptysis, and bronchoscopy should be used in diagnosis as soon as possible.