纤维支气管镜检查在抗酸杆菌阴性肺结核诊断中的应用价值  

Value of Fibreoptic Application of Bronchoscopy in Preventing Misdiagnosis of Negative Sputum Specimen Pulmonary Tuberculosis

作　　者：张德厚[1] 李坚[1] 张蓝石[1] 施潮[1] 

机构地区：[1]江苏大学附属医院,江苏镇江212001

出　　处：《临床误诊误治》2008年第4期3-5,共3页Clinical Misdiagnosis & Mistherapy

摘　　要：目的:评价纤维支气管镜(纤支镜)检查在痰涂片抗酸杆菌阴性(菌阴)肺结核诊断中的作用。方法:对应用纤支镜检查确诊的92例菌阴且临床表现不典型肺结核病例资料进行回顾性分析。结果:本组39例纤支镜下见支气管黏膜有异常改变,其中29例(74.4%)刷检涂片找抗酸杆菌阳性,活检有结核病理改变23例(59.0%);另外53例病灶位于外周部位,纤支镜下未见明显异常,经支气管肺活检(TBLB)抗酸杆菌阳性42例(79.2%),刷检涂片抗酸杆菌阳性24例(45.3%),支气管肺泡灌洗液涂片检查抗酸杆菌阳性15例(28.3%)。结论:对痰涂片抗酸杆菌阴性肺结核,尤其是临床表现不典型者,纤支镜检查有助于明确诊断。Objective： To evaluate the value of fibreoptic bronchoscopy （FB） in preventing misdiagnosis of negative sputum specimen pulmonary tuberculosis （PTB）. Methods：We retrospectively reviewed the records of 92 PTB patients diagnosed as non-typical TB ,who were sputum smear-negative for acid-fast bacilli or were unable to produce sputum spontaneously. Results：Among 92 patients,endobronchial abnormal change can be found by FB in 39 patients,brush smear specimens obtained from 29 patients （74.4%） were examined for the presence of acid-fast bacilli, and biopsy specimen provided pathology diagnosis in 23 patients （59.0%）. Pulmonary lesion of other 53 patients was located in the outer area of lung and transbronchial lung biopsy specimen was positive in 42 patients （79.2%） , brush smear for acidfast bacilli was positive in 24 patients （45.3%） , bronchoalveolar lavage fluid smear was positive in 15 patients （28.3%）. Conclusion.FB is helpful in preventing misdiagnosis of patients with PTB of negative sputum specimens especially without typical clinical manifestations.

关 键 词：结核 肺 支气管镜检查术 结核分枝杆菌 

分 类 号：R521[医药卫生—内科学]