纤维支气管镜检查对菌阴肺结核诊断的意义

The diagnostic significance of bronchofibroscopy in pulmonary tuberculosis cases with tubercle bacillus undetected.

目的 探讨痰菌阴性肺结核纤维支气管镜检查的镜下改变及诊断意义。方法 应用OlympusFB 10型纤支镜 ,利多卡因局部麻醉 ,操作按技术常规进行。结果 76例受检患者中 70例镜检发现异常 ,主要表现有充血肿胀 6 8.5 7% (48/ 70 ) ,糜烂渗血 2 4.2 9% (17/ 70 ) ,肉芽结节 18.5 7% (13/ 70 ) ,管腔变形 34 .2 9% (2 4/ 70 ) ,增厚粗糙 12 .86 % (9/70 ) ;与X线诊断病变部位相符合者 6 5例 (85 .5 3% ) ;镜检后通过病理组织学、细胞学涂片、BALF涂片及术后痰菌检查明确结核诊断者 5 3例 (75 .71% )。结论 菌阴肺结核缺乏诊断“金标准” ,纤支镜检查对于临床表现不典型 ,痰菌检查三次以上阴性 ,又不能除外肺结核病的患者 ,不失为提高其诊断率的又一重要途径。

Objective To investigate the diagnostic significance and changes under bronchofibroscopy in pulmonary tuberculosis cases with tubercle bacillus undetected(uTB PT).Methods Bronchofibroscopy(Olympus BF 10 type) and local anesthesia by lidocaine were performed in terms of the regulation of operation.Results Of 76 cases examined,70 were abnormal.The main presentations were hyperemia and mucosa swelling(48/70 or 68.57%),yellow white nodes(13/70 or 18.57%),deformation and distortion of lumen (24/70 or 34.29%),and granulation hyperplasia(9/70 or 12.80%).The sites of lesions located by bronchofibroscopy and those located by X ray diagnosis coincided by 85.53%.After bronchofibroscopy,53(75.71%) cases that had been diagnosed as tuberculosis were corroborated by pathology,cytology of bronchoalveolar lavage fluid(BALF) smear and examination for acid fast bacilli in sputum.Conclusion Now that the diagnosis of uTB-PT is short of “gold standard”,bronchofibroscopy is another important way to enhance the rate of diagnosis for patients whose clinical manifestations are not typical,whose sputa have been negative for acid fast bacilli more than 3 times,and for whom the differential diagnosis can not rule out pulmonary tuberculosis.