摘要
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Olympus FB-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68.57%(48,70),糜烂渗血24.29%(17/70),肉芽结节18.57%(13/70),管腔变形34.29%(24/70),增厚粗糙12.86%(9/70);与 X 线诊断病变部位相符合者65例(85.53%);镜检后通过病理组织学、细胞学涂片、BALF 涂片及术后痰茵检查明确结核诊断者53例(75.71%)。结论:茵阴肺结核缺乏诊断"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 bronehofi- broscopy in pulmonary tuberculosis cases with tubercle bacillus undetected(uTB-PT).Methods:Bron- chofibroscopy(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 presentation were hyperemia and mucosa swelling(48/70 or 68.57%),yellow-white nodes(13/70 or 18.57%),defor- mation and distortion of lumen(24170 or 34.29%),and granulation hyperplasia(9170 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 corrob- orated by pathology,cytology of bronchoalveolar lavage fluid(BALF)smear and examination for acid- fast bacilli in sputum.Conclusion:The diagnosis of uTB-PT is short of'gold standard'.Bronchof- ibroscopy is another important way to enhance the rate of diagnosis for patients whose clinical manifesta- tions 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.
