支气管内膜结核50例临床分析

Clinical Analysis of 50 Cases With Endobronchial Tuberculosis

目的 :探讨支气管内膜结核 ( EBTB)的临床特征和早期诊断方法。方法 :分析 5 0例经纤维支气管镜 (纤支镜 )确诊的支气管内膜结核患者的临床表现、胸部 X线 ( CT) ,纤支镜检查等结果。结果 :主要症状 :咳嗽 48例 ,发热 39例 ,咯血或血丝痰 2 0例 ,消瘦 17例 ,盗汗 14例 ,胸痛 10例 ,胸闷、气促 7例 ,喘鸣 3例。X线表现 3例正常 ,2 8例 CT检查无一例报告提示 EBTB。纤支镜检查 :炎症浸润型病变占 40 % ,增殖型病变 10 % ,狭窄闭塞型病变 16% ,溃疡型病变 2 4% ,大致正常10 %。42例痰涂片找抗酸杆菌 7例阳性。5 0例行纤支镜刷片检查 38例阳性 ,5 0例行活组织病理检查 2 0例确诊为结核。结论 :EBTB缺乏特异性临床表现 ,胸部 X线表现正常不能排除 EBTB,CT诊断价值不高 ,确诊主要依靠纤支镜检查。

Objective to explore the clinical features and early definite diagnosis of endobronchial tuberculosis (EBTB).Methods clinical symptoms,chest X ray/CT manifestations and fiberoptic bronchoscopic findings of 50 cases with EBTB were analyzed.Results main symptoms were as follows:Cough in 48 Cases,fever in 39,haemoptysis in 20,Weght loss in 17,sweated while sleeping in 14,pleural pain in 10,pleural pressing feeling,dyspnea in 7,localized wheezing in 3.3 cases in chest x ray were normal,28 cases in CT,with out one case indicative of EBTB.Bronchoscopic results showed exudative lesions in 40% of the cases, granulomatous lesions in 10%,cicatricial lesions in 16%,ulcerative lesions in 24%, and ,normal like demonstrations in 10%.Positive result were found in 7 out of 42 by sputum acid fast staining,38 out of 50 by bronchoscopic brushing smears,and 20 out of 50 by bronchial biopsies.Conclusions:The clinical features of EBTB are nonspecific,and EBTB can not be excluded only by normal chest X ray fondings.In contrast to CT,bronchoscopy plays an important role in definite diagnosis of the disease,when patients with slight fever of unknown origin or respiratory symptoms do not respond to general treatment,EBTB should be suspected and early fiberoptic bronchoscopy be performed.Fiberoptic bronchoscopic brusing examination for acid fast bacillus and bronchial biopsy are beneficial to rapid definite diagnosis of EBTB.