纤维支气管镜诊断活动性肺结核病临床分析

Clinical value of fiberoptic bronchoscopy in diagnosis of active pulmonary tuberculosis

目的探讨纤维支气管镜对于活动性肺结核病的诊断价值。方法收集2013年10月至2016年4月在天津市儿童医院呼吸感染科收治的5例经纤维支气管镜确诊的肺结核病患儿临床资料,总结分析其临床特点和诊治经过。结果 5例患儿中男3例,女2例,年龄1~13岁,病程12~35 d。5例免疫功能检查均未见异常。起病均急骤,3例伴发热,2例伴反复咳喘。3例曾于外院误诊为肺炎、婴幼儿喘息;1例误诊为肺化脓症、先天性肺囊性病变继发感染(?);1例误诊为肺炎、胸膜炎。5例均否认结核接触史,按时接种卡介苗,1例卡介苗瘢痕阴性。病变侵及肺及胸膜,其中肺结核病3例(其中1例继发左主支气管狭窄),支气管内膜结核2例。患儿均予抗痨治疗后出院(平均住院11 d),预后良好。结论儿童肺结核病具有症状、体征、影像学不典型,以及纤维支气管镜下病变不典型等特点,提示对咳喘迁延反复、常规抗感染治疗无效的患儿,应积极行纤维支气管镜检查协助临床诊断。

Objective To evaluate the clinical value of fiberoptic bronehoscopy in diagnosis of active pulmonary tuber- culosis. Methods Clinical data of 5 children with tuberculosis confirmed by fiberoptic bronchoscopy was collected, who were treated in Tianjin Children＇s Hospital from Oct. 2013 to Apr. 2016. The clinical features and treatment proce- dure of the 5 cases were analyzed. Results The age of the 5 cases （3 male and 2 female） ranged from 1 to 13 years old with the disease course of 12-35 days. The immune function of the 5 cases were normal. All of the eases were with abrupt onset. 3 cases had fever, 2 cases had recurrent cough. Three cases misdiognosed as pneumonia and infant wheezing. One case was misdiagnosed as pulmonary abscess. One case was misdiagnosed as pneumonia. All of the 5 cases denied hav- ing tuberculosis contact history and all the patients received regular BCG vaccination. Lesion invased the lung and pleu- ral with 3 cases diagnosed as lung tuberculosis （ 1 case with secondary left main bronchial stenosis） and 2 cases as tuber- culosis of bronchus. All of the cases received regular anti-tuberculosis treatment and were discharged with the hospital- ization of 11 days. The outcome was good. Conclusion The clinical symptom, sign and bronchoscopic features were not typical in children with tuberculosis. For children with the symptom of persisting cough who don＇ t respond to conven- tional anti infection treatment ,fiberoptic bronchoscopy examination is recommended to help make clinical diagnosis.