气管支气管内膜结核的CT影像诊断及临床意义  

The Value of CT in Diagnosis of Endotracheal and Endobronchial Tuberculosis

作　　者：方伟军[1] 吴雪娜[2] 张颖[3] 华蓉[1] 张晖[1] 王敏[2] 

机构地区：[1]广州市胸科医院暨广州肺部疾病肿瘤研究所放射科,广州510095 [2]南昌大学第一附属医院放射科,南昌330006 [3]广东省中医院放射科,广州510000

出　　处：《实用临床医学（江西）》2007年第2期102-106,108,共6页Practical Clinical Medicine

摘　　要：目的:探讨气管支气管内膜结核的CT影像表现,评价CT检查对气管支气管内膜结核诊断价值,及提高对气管支气管内膜结核的认识。方法:回顾性分析178例经纤维支气管镜、病理证实的气管支气管内膜结核的胸部CT影像表现。178例均行CT平扫,其中73例行增强检查。结果:(1)共292处气管、主支气管及叶段支气管受累,右肺稍多于左肺,累及双上、左下肺叶、双侧主支气管最多。(2)发病年龄以21-50,61-80岁范围的人员多见。(3)局部CT影像特点为:①病变范围较广,常见多个支段受累。本组病例中有60例累及2叶段以上;②病变支气管范围长,多为主支气管、叶支气管、段支气管连续或间断受累;③管腔多为不规则狭窄,有串珠状改变;④管壁多为不规则增厚,但其管壁外径未见增大,即中心性增厚,内径缩小。本组有152例管壁有增厚,伴管壁密度增高或钙化;⑤肺部多见结核并发灶。本组约有130例肺部合并病灶,105例有相应部位的肺不张;⑥肺门纵膈一般无肿块影。病变支气管壁的表现与支纤镜病理分型有相关性。结论:CT对显示气管、支气管内膜结核的累及范围有一定的优势,对临床确诊气管支气管内膜结核及大致分期、治疗方法的选择有重要作用。Objective： To investigate the CT findings of Endobronchial Tuberculosis, and to evaluate the value of CT in demonstrating Endobronchial Tuberculosis, and to make a further understanding of the disease. Methods： CT findings of Endobronchial Tuberculosis in 178 cases were analyzed retrospectively, all patients were diagnosed definitely by pathology. All patients were underwent CT native scan, and enhanced CT scan were performed on 73 of them. Results： （1）A total of 292 bronchi was affected. The right lung was more affected than The Left lung, with both main bronchus.both upper lobes and the left lower lobes being most frequently involved. （2）people with age from 21 to 50 and from 61 to 80 years old were more caught the disease. （3）the focal CT features of Endobronchial Tuberculosis were as follows： （1） multiple bronchi and segments were invaded,in all cases, two bronchi and segments or more were affected in 60 cases; （2）The main bronchi,lobar and segmental were usually affected continuously or Intermittently, with a longer extension; （3） The bronchial lumen was often stenosed irregularly; （4） the bronchial walls were always thickened irregularly in most cases ,but only inside diameter of bronchi deflate,outside diameter of bronch was unchanged, there were high attenuation or some calcification in thichening bronchial walls;（5）there were some intra thoracis tuberculosis foci and atelectasis;（6） generally, there were no intumescent lympaden in the mediastinum and hilum of lung. Pathologic classification correspond to classification of the CT findings. Conclusion：Concentric bronchial wall thickening which affects acertain segment of the bronchus is the main sign of EBTB. CT well demonstrated the number and location of Endobronchial Tuberculosis, and lead to a correct diagnosis in most cases.

关 键 词：结核 支气管 X线计算机 

分 类 号：R521.2[医药卫生—内科学]