支气管镜检查对痰菌阴性肺结核的诊断价值探讨

Clinical value of bronchoscopy in dignosis of bacteriological negative pulmonary tuberculosis

目的探讨支气管镜下多种方法取材对痰菌阴性肺结核的诊断价值。方法回顾分析74例肺结核患者的临床资料，所有患者均行3次或以上痰抗酸染色，痰菌阳性者25例，痰菌阴性或无痰49例，其中28例行支气管镜活检、刷检涂片、支气管肺泡灌洗液（BALF）涂片及镜后痰检。结果28例接受检查者镜下发现异常14例，占50．0％；病变处活检或经支气管镜肺活检（TBLB）病理符合典型结核表现15例，占53．6％；刷片抗酸染色阳性7例，占25．0％；BALF涂片阳性10例，占35．7％；镜后痰检阳性6例，占21．4％；多项指标联合，最终确诊23例，占82．1％。结论支气管镜检查下多种方法取材，对痰菌阴性肺结核诊断具有重要意义，有条件可尽早实施。

Objective To explore the diagnostic value of bronchoscopy combined materials drawn in multiply methods in patients with bacteriological negative pulmonary tuberculosis. Methods The clinical data of 74 patients with pulmonary tuberculosis were retrospectively analyzed. All the patients had sputum acid-fast staining more than three times,25 patients were sputum bacteriological positive and 49 patients were bacteriological negative or had no sputum. Bronehoscopy was performd in 28 cases, including biopsy examining, brush examining, bronehoalveolar lavage fluid（BALF） smear and sputum spear acid-fast stain test. Results In 28 patients undergoing examination, micro-scopic abnormalities were found in 14 cases ,taken 50.0%. 15 cases performed lesion biopsy or transbronchiallung biopsy（TBLB） were diagnosed tuberculosis, taken 53.6%. Brush acid-fast staining was positive in 7 cases, taken 25.0%. BALF smear postive in 10 cases ,taken 35.7%. And phlegm test after bronchoscope positive in 6 cases ,taken 21. 4%. Combined multiply index, 23 eases finally diagnosed as pulmonary tuberculosis, taken 82. 1%. Conclusion Bronchoscopy with materials drawn in multiply methods has a high value in diagnosing bacteriological negative pulmonary tuberculosis, we should take advantage of it as soon as possible.