气管、支气管结核误诊原因及早期诊断方法的探讨  

Misdiagnosis reasons and methods of the early definite diagnosis on trachea and bronchial tuberculosis

作　　者：金发光[1] 刘同刚[1] 谢永宏[1] 傅恩清[1] 楚东岭[1] 刘春丽[1] 刘伟[2] 钱桂生[3] 吴国明[3] 

机构地区：[1]第四军医大学唐都医院呼吸内科,陕西西安710038 [2]中国人民解放军323医院呼吸内科,陕西西安710054 [3]第三军医大学新桥医院全军呼吸内科研究所,重庆400037

出　　处：《中国内镜杂志》2006年第5期449-451,455,共4页China Journal of Endoscopy

摘　　要：目的探讨气管、支气管结核的误诊原因及其早期正确诊断的方法。方法回顾性分析150例被误诊的气管、支气管结核患者的临床资料、误诊原因和诊断方法。结果临床症状缺乏特征性,以刺激性干咳为主(75.0%),其次为间断性咯血、发热、胸闷、气促等,结核中毒表现不明显或缺如;临床影像学无典型性,可表现为正常、斑片状阴影、肺不张、阻塞性肺炎、肺门影增大和肺门肿块等;误诊疾病主要为肺癌并肺不张(49.0%)、肺炎(23.3%)和支气管炎(17.3%),其他依次为肺结核、支气管扩张症、结核性胸膜炎和哮喘等;支气管镜下表现为肉芽增殖型(36.7%)、炎症浸润型(28.0%)、溃疡坏死型(24.0%)、瘢痕狭窄型(11.3%)。病变部位以左肺(49.4%)多于右肺(37.2%),左支气管受累比例最大(22.7%),病变遍及所有叶段支气管;150例中经支气管镜活检诊断131例(87.3%),毛刷涂片抗酸染色细菌学诊断41例(27.3%)。结论气管、支气管结核在临床症状、影像学和结核菌痰检学方面缺乏特征性,极易误诊。误诊的主要原因是临床医师对该病认识不足和不重视或放弃支气管镜检查。支气管镜活检和刷检是目前诊断气管、支气管结核最可靠和最准确的方法,值得临床医师推广应用。[Objective] To explore misdiagnosis reasons and methods of early definite diagnosis on trachea and bronchial tuberculosis. [Methods] Clinical symptoms, misdiagnosis reasons and diagnosis methods of 150 patients being misdiagnosed were retrospectively investigated. [Results] The clinical features were non-specific. An activated dry cough was the most common complaint in 75%, and the others were intermittent hemoptysis, fever, dyspnear etc. There were no and/or less clinical poisoning symptoms of tuberculosis. Clinical chest roentgenographic presentations were non-typical. Chest roentgenographic were normal, shape, atelectasis, keratosis pheumonitis, swelling of hitum of lung etc. Lung cancer and atelectasis together were the most common reasons in 49%, pheumonitis in 23.3%, bronchitis in 17.3%, and the others were lung tuberculosis, tuberculous pleuritis, asthma in return. Bronchoscopic findings showed that main pathologic changes included 36.7% granulation, 28% mucosa inflammation, 24% ulceration （or necrosis） and 11.3% cicatricial stenosis. Left lung（49.4%） was more often affected the right, and left bronchi is in the most-22.7%. The disease affected all leaf and segment bronchi. 131 cases （87.3%） were diagnosed by bronchoscopic biopsy; 41 cases （27.3%）were diagnosed by bronchoscopic brushing examination for acid-fast bacillus. [Conclusion] The clinical features, roentgenographic presentations and examination for acid-fast bacillus of trachea and bronchial tuberculosis are non-specific and easy to be misdiagnosed. Clinical doctors have less knowledge of this disease and neglecting or giving up early are the main reasons to be misdiagnosed. Bronehoseopie brushing examination for acid-fast bacillus and bronchoscopic biopsy should be the most reliable and accurate step to get the definite diagnosis, and could be used widely in clinical applications.

关 键 词：结核 气管 支气管 误诊 支气管镜检查 诊断 

分 类 号：R562[医药卫生—呼吸系统] R523[医药卫生—内科学]