支气管结核临床分析  

Clinical Analysis of Endobronchial Tuberculosis

作　　者：何朝文[1] 李党育[1] 刘立义[2] 李柏完[3] 

机构地区：[1]广西壮族自治区南溪山医院呼吸内科,广西桂林541002 [2]广西医科大学附属肿瘤医院内镜中心,南宁530021 [3]南华大学附属第三医院呼吸内科,湖南衡阳421900

出　　处：《临床误诊误治》2011年第10期55-57,共3页Clinical Misdiagnosis & Mistherapy

摘　　要：目的对支气管结核(EBTB)的临床特点和支气管镜下形态进行分析,探讨其临床诊断要点。方法回顾性分析我院2005年3月～2010年2月收治的102例EBTB的临床表现、影像学征象和内镜下形态等临床资料。结果本组临床表现为咳嗽95例,咳痰84例,盗汗56例,发热54例,乏力、消瘦52例,咯血45例,咳血痰32例及胸痛24例。X线胸片示肺结核影像征象26例,肺过度充气24例,阻塞性肺炎23例,肺不张21例,支气管扩张16例,肺充气不良12例,气管狭窄5例;肺部CT表现为管腔狭窄36例,管壁局部增厚32例,肺结核征象30例,管腔闭塞23例,肺不张21例,管腔内肿物15例,管壁棘状突起12例。支气管镜下表现为炎症浸润型18例,溃疡坏死型28例,肉芽增殖型25例,瘢痕狭窄型15例,管壁软化型6例,混合型10例。本组漏诊23例,误诊56例,漏误诊率达77.4%。治愈96例,失访6例。结论 EBTB的临床和影像学征象无特异性,易误诊。提高临床医师对EBTB的警惕性和支气管镜下表现形态的认识,结合内镜下组织活检、刷检以及镜后的痰检,能有效减少EBTB漏误诊。Objective To investigate clinical characteristics and the bronchoscopy features of endobronchial tuberculosis（EBTB）and investigate the main key points in diagnosis.Methods The clinical manifestations,imaging signs and bronchoscopic features of 102 EBTB patients admitted into our hospital during Mary 2005 and February 2010 were analyzed retrospectively.Results 95 patients had a cough,84 had expectoration,56 had night sweat,54 had a fever,52 had fatigue weight loss,45 had hemoptysis,32 had hemoptysis sputum and 24 had chest pain.Chest X-ray showed that 26 patients had the imaging signs of tuberculosis,24 had lung hyperinflation,23 had obstructive pneumonia,21 had atelectasis,16 had bronchiectasis,12 had poor lung inflation and 5 had tracheal stenosis in the performance.The CT results showed that 36 had stenosis,32 had local thickening of the wall,30 had imaging signs of tuberculosis,23 had luminal occlusion,21 had atelectasis,15 had intraluminal tumor,and 12 had wall spinous process.The bronchoscopic features showed that 18 patients were exudative type,28 were ulcerative and caseating type,25 were granular type,15 were cicatrical type,6 were bronchus collapse type,and 10 were mixed type.23 patients had missed diagnosis,56 were misdiagnosed.The missed diagnosis and misdiagnosis rate was 77.4%.96 patients were cured,and 6 patients were lost in follow-ups.Conclusion EBTB tends to be misdiagnosed because the clinical symptoms and imaging signs of EBTB are not specific.To increase vigilance and improve to knowledge of the diversity of the bronchoscopic manifestations in combination with endoscopic biopsy and finding acid-fast bacilli in bronchial brush slice and sputum smear after bronchoscopy can reduce missed-diagnosis and misdiagnosis rates.

关 键 词：支气管 结核 支气管镜检查 诊断 鉴别 

分 类 号：R521.2[医药卫生—内科学]