电子支气管镜检查在菌阴肺结核中的诊断价值

The Diagnostic Value of Electronic Bronchoscope in Pulmonary Tuberculosis Cases with Tubercle Bacillus Undetected

目的探讨电子支气管镜检查在痰菌阴性肺结核中的诊断价值。方法回顾性分析60例菌阴肺结核患者的电子支气管镜检查结果,了解镜下表现及组织活检病理、支气管镜刷检涂片和术后痰涂片找抗酸杆菌3种不同取材方法对肺结核诊断的阳性率。结果 60例患者中54例镜检发现异常,电子支气管镜主要表现为黏膜充血水肿36.7%(22/60)、溃疡或干酪样坏死13.3%(8/60)、增厚粗糙6.7%(4/60)、管腔狭窄21.7%(13/60)及肉芽肿样结节11.7%(7/60)。组织活检、刷检涂片及术后痰涂片检查的阳性率分别是59.3%、66.6%和43.3%,全部病例均经电子支气管镜确诊,确诊率100%。结论电子支气管镜检查在菌阴肺结核诊断中有重要价值,可提高确诊率,减少误诊。

Objective To investigate the diagnostic value of electronic bronchoscope in pulmonary tuberculosis cases with tubercle bacillus undetected（uTB-PT）.Methods The results of electronic bronchoscope examinations of 60 patients with uTB-PT were retrospectively analyzed,in order to know the main presentations under electronic bronchoscope and the positive rate of diagnosis of pulmonary tuberculosis about pathological biopsy,bronchial brushing smear and sputum smear acid-fast stain test.Results Among 60 patients,macroscopic abnormality can be directly observed in 54 patients.The main presentations under electronic bronchoscope were hyperemia and mucosa swelling 36.7%（22/60）,ulcers or caseous necrosis 13.3%（8/60）,granulation hyperplasia 6.7%（4/60）,stenosis of lumen 21.7%（13/60） and granuloma-like nodules 11.7%（7/60）.The positive rates of pathological biopsy、brushing smear and sputum smear acid-fast stain test were 59.3% 、66.6%、43.3% respectively.All cases were examined by electronic bronchoscope.The final diagnosis rate was 100%.Conclusion Electronic bronchoscope examination has important diagnostic value in pulmonary tuberculosis cases with tubercle bacillus undetected.It can improve the final diagnosis rate and reduce misdiagnosis rate.