支气管镜在不典型肺结核诊断中的应用  

Application of bronchoscopy in the diagnosis of atypical pulmonary tuberculosis

作　　者：赵云根[1] 孟逸萍[1] 陈雪娟[1] 由振华[1] 顾宇平[1] 张晓东[1] 

机构地区：[1]江苏省常熟市第二人民医院呼吸内科,常熟215500

出　　处：《临床医学》2014年第6期9-11,共3页Clinical Medicine

摘　　要：目的探讨不典型肺结核的特点及基层医院支气管镜对不典型肺结核的诊断意义。方法对应用支气管镜确诊的28例临床不典型、痰菌阴性的肺结核患者的临床资料进行回顾性分析。结果本研究中28例患者的临床症状缺乏特征性,临床影像学缺乏典型性,胸部影像学检查以肺内片状阴影(57.1%)多见,影像学无明显异常者占14.3%。本研究28例支气管镜下见支气管黏膜有异常改变,炎症浸润型病变20例,干酪坏死型病变2例,肉芽增生型型病变4例,纤维狭窄型病变2例。其中刷检涂片找抗酸杆菌阳性22例(78.6%),活检有结核病理改变6例(21.4%),术后痰菌阳性6例(21.4%),三者联合确诊28例(100%)。结论支气管镜对不典型肺结核的诊断具有重要的临床应用价值,值得基层医院推广应用。Objective To investigate the clinical features of atypical pulmonary tuberculosis,and the effect of bronchoscopy on the diagnosis of atypical pulmonary tuberculosis in basic-level hospitals Methods The clinical data of 28 non-typical pulmo-nary tuberculosis patients with negative sputum smears,were retrospectively analyzed. Results The clinical features were atypi-cal in 28 patients,and the clinical chest roentgenographic presentations were atypical. Shape in lung as the most common chest roentgenographic presentation accounting for 57. 1% . Norma chest roentgenographic presentation accounting for 14. 3% . Endo-bronchial abnormal change can be found by bronchoscopy in 28 patients,20 patients had infiltrating inflammatory lesions,2 pa-tients had cheese necrotizing granulomatous lesions,4 patients had proliferative lesion,and 2 patients had fiber-type lesion steno-sis. Brush smear specimens obtained from 22 patients（78. 6% ）were podsitive by the brush smear specimens for the presence of acid-fast bacilli,and 6 cases（21. 4% ）had pathological changes of tuber culosis by biopsy,and examination for acid-fast bacilli in sputum was positive in 6 patients（21. 4% ）. Twenty-eight cases（100% ）were diagnosed by the joined detection. Conclusion Bronchoscopy has significant clinical value on the diagnosis of atypical pulmonary tuberculosis,and is worthy to be popularized in basic-level hospitals.

关 键 词：支气管镜 不典型肺结核 诊断 

分 类 号：R521[医药卫生—内科学]