支气管镜在气管支气管结核诊断中的临床价值

Application of bronchoscope in the diagnosis of tracheobronchial tuberculosis

目的探讨支气管镜检查在气管支气管结核诊断中的临床应用价值,以用于气管支气管结核早期诊治。方法收集唐都医院呼吸内科2013年11月1日至2015年10月31日诊断的气管支气管结核212例住院患者临床资料,分析支气管镜检查结果及临床特点。结果 212例患者中,经电子支气管镜检查确诊为气管、支气管结核患者,其中痰菌阳性患者151例(71.2%),合并肺结核者195例,合并其他肺外结核者17例,具有结核中毒症状者182例,支气管镜下溃疡坏死型最多(29.7%)。由于气管支气管结核临床表现不特异,临床误诊率高,本组212例患者中,误诊率高达25.9%,误诊时间最长为8个月,临床危害大。结论支气管镜检查在气管支气管结核诊断中具有重要的临床价值。

Objective To discuss and study the application of bronchoscope in the diagnosis of tracheobronchial tuberculosis. Methods A total of 212 lung tuberculosis patients in our hospital from November 1,2013 to October 31,2015 were selected as the experimental group,the clinical data were analyzed such as medical history,a physical exam,chest computed tomography,mycobacterial analysis of sputum samples,endoscopic types and patohistological confirmation. Results Among the 212 patients,58.0%of the patients were females. Sputum examination showed acid-fast bacilli in 151（ 71.2%） patients. The most common radiographic localization was in the upper lung lobes（ 63.5%） and so variable that we could not make a precise diagnosis. The most common endoscopic subtype determined by bronchoscopy were ulcer-necrosis subtype（ 29.7%）. Tracheobronchial tuberculosis has no specific clinical feature and was easily misdiagnosed.Conclusions Clinical course of tracheobronchial tuberculosis is quite variable with frequent progression,while bronchiscopy has high clinical value in diagnosis of patients with tracheobronchial tuberculosis.