支气管镜检查对非典型肺结核的诊断价值

Diagnostic Value of Bronchoscopy for Atypical Pulmonary Tuberculosis

目的：分析非典型肺结核患者的临床资料、胸部影像表现及支气管镜镜下特征,为临床诊治非典型肺结核提供理论依据。方法：采用回顾性病历研究方法,收集山西省人民医院2013年9月～2015年3月经支气管镜检查活检病理证实或涂片找到抗酸杆菌,且病历资料完整的53例患者,对非典型肺结核患者的临床资料、胸部影像学特征及支气管镜下表现进行分析总结。结果：53非典型肺结核患者中,临床表现主要为咳嗽（22例）,咳痰（14例）,胸闷、气短（9例）,胸痛（13例）,咯血（15例）,发热较少（7例）;纤维支气管镜下表现,以管腔黏膜充血、水肿、管腔狭窄、白色苔膜附着多见;胸部影像学无特征性,以实变影、片状高密度影、团块状影为主。误诊常见疾病有肺炎、肺癌、肺脓肿等。结论：＂非典型＂肺结核临床表现及影像学表现无特异性,极易导致误诊,支气管镜检查有助于确诊。

Objective： To analyze the clinical data,chest imaging findings and microscopic features of bronchoscopy in the patients with pulmonary tuberculosis for the clinical diagnosis and treatment of atypical tuberculosis atypical,providing timely theoretical basis. Method： Clinical data of 53 cases of ＂ atypical＂ TB patients,chest radiographic features and bronchoscopy performance in the respiratory department of our hospital from September 2013 to March 2015,after brushing bronchoscopy confirmed were retrospectively analyzed and summarized. Result： Among 53 ＂ atypical＂ TB patients,the clinical manifestations were cough（ 22 cases）,sputum（ 14 cases）,chest tightness,shortness of breath（ 9cases）,chest pain（ 13 cases）,hemoptysis（ 15 cases）,less fever（ 7 cases）. The representation was the bronchoscopy with luminal mucosal edema,stenosis,white moss membrane attachment common; chest radiographic opacities showed the flake high density,mission-based massive shadow without any special marks; the common diseases were misdiagnosed as pneumonia,lung cancer,lung abscess,etc. Conclusion： Due to less specificity in clinical manifestation and imaging expressions for atypical pulmonary tuberculosis,which is easily misdiagnosed,the bronchoscopy will benefit the diagnose.