经支气管针吸活检术在儿童肺结核诊断中的应用

Application of transbronchial needle aspiration in diagnosis of tuberculosis in children

目的:探讨经支气管针吸活检术(TBNA)在儿童纵隔淋巴结大肺结核诊断中的作用和临床意义。方法:回顾性研究山东大学附属儿童医院呼吸介入科2014年3月至2019年7月收治的8例纵隔淋巴结大肺结核患儿的临床资料。患儿均经胸部强化CT诊断纵隔淋巴结大后行TBNA并最终确诊,总结TBNA诊断经验。结果:8例纵隔淋巴结大患儿,年龄7个月~8岁6个月(婴幼儿占75.0%),中位年龄为22.5个月;男3例(37.5%),女5例(62.5%);体质量8.5~39.0 kg,中位体质量为10.7 kg;病程15~90 d,中位病程为18.5 d。临床表现有咳嗽8例,发热4例,喘息1例,喉鸣1例。行常规支气管镜检查及TBNA,留取细胞学、病原学、病理检查,6例患儿获得确诊依据,诊断率为75.0%,4例涂片中找到抗酸杆菌但病理检查阴性,1例病理符合结核感染特点但涂片检菌阴性,1例涂片及病理均提示结核。2例患儿未经TBNA检查取得病原学及组织学证据,根据肺泡灌洗液涂片抗酸染色阳性明确诊断。患儿术中、术后均无并发症发生。结论:TBNA是诊断儿童肺结核的重要手段,其有效、安全,有较高临床应用价值。

Objective To investigate the application of transbronchial needle aspiration(TBNA)in the diagnosis of tuberculosis with mediastinal lymphadenopathy in children.Methods A retrospective study was conducted on clinical data in 8 children of tuberculosis with mediastinal lymphadenopathy treated in the Center for Respiratory Intervention,Children′s Hospital Affiliated to Shandong University from March 2014 to July 2019.TBNA was performed after the mediastinal lymphadenopathy were diagnosed by chest enhanced CT and the final diagnosis was made.The diagnostic experience of TBNA was summarized.Results Eight children with mediastinal lymphadenopathy included in this present study aged from 7 months to 8 years and 6 months(infants accounted for 75.0%),with a median age of 22.5 months.There were 3 males(37.5%)and 5 females(62.5%).The body mass was 8.5-39.0 kg,and the median body mass was 10.7 kg.The course of disease was 15-90 days,and the median number of days was 18.5 days.The clinical manifestations included cough in 8 cases,fever in 4 cases,wheezing in 1 case and laryngeal ringing in 1 case.Bronchoscopy and TBNA biopsy were performed.Cytology,etiology and pathology were examined after TBNA.A definite diagnosis could be made in 6 children,with a diagnosis rate of 75.0%.Among them,4 cases were found with acid-fast bacilli in smear but pathological examination was negative;1 case was pathologically conformed to the characteristics of tuberculosis infection but the smear was negative;the smear and pathology of 1 case were both suggestive of tuberculosis;2 cases did not present etiological and histological evidence with TBNA.The diagnosis was made according to the positive acid-fast bacilli of alveolar lavage fluid smear.There were no complications during and after operation.Conclusions TBNA is an important method to diagnose tuberculosis in children,which is effective,safe and has high clinical application value.