经纤维支气管镜诊断支气管内膜结核102例分析

Clinical analysis of 102 cases with endobronchial tuberculosis diagnosed by fiberoptic bronchoscopy.

目的： 探讨支气管内膜结核EBTB的临床特征和早期确诊手段。方法：回顾分析102例经纤维支气管镜（纤支镜）确诊的EBTB患者的临床表现、胸部影像学表现、纤支镜检查结果。结果： 本组中位年龄39岁,男女比例为1∶1．3。临床症状以顽固性干咳、气促为主65例，血痰为主19例，喘鸣为主12例，有结核中毒症状26例，无明显症状6例。胸部影像学资料无明显异常27例。纤支镜检查示：左侧多于右侧，47％的病例以瘢痕狭窄为主，溃疡或坏死为主13％，肉芽增生为主16％，黏膜炎性病变为主24％。全部病例经纤支镜病理活检和（或）刷检找抗酸杆菌确诊。结论： EBTB缺乏特异性的临床表现，胸部影像学检查正常并不能排除EBTB，纤支镜检查是确诊EBTB最重要的手段。

s] Objective: To discuss the clinical features and early definite diagnosis of endobronchial tuberculosis EBTB． Methods: Clinical symptoms, chest roentgenographic presentations and fiberoptic bronchoscopic findings of 102 patients diagnosed by fiberoptic bronchoscope were retrospectively investigated． Results: Median age of the EBTB patients were 39, with 1．3 times higher incidence noted in female than in male subjects． An intractable cough with dyspnear was the most common complain in 65 cases, Wheezing was in 12, bloody sputum was in 19． No clinical complain was seen in 6, above all 26 patients accompanied by poisoning symptoms of tuberculosis． Chest roentgenographic presentations of 27 patients were normal． Bronchoscopic findings showed that left bronchial was more often affected than right, and main pathologic changes included 47％ cicatricial stenosis, 13％ ulceration or necrosis, 16％ granulation and 24％ mucosa inflammation． All the patient were diagnosed by bronchoscopic brushing examination for acid fast bacillus, and／or bronchial biopsy． Conclusion: The clinical features of EBTB are non specific, and chest roentgenographic presentations may be normal, if the diagnosis is suspected, an early fiberoptic bronchoscopy should be the most important step to get the definite diagnosis．