淋巴结瘘型支气管结核的支气管镜下特征及介入治疗效果分析  

The bronchoscopic features of endobronchial tuberculosis induced by lymphatic fistula and the efficacy of interventional treatment

作　　者：方琼[1] 李映文[1] 谢艺开[1] 刘红英[1] 韦曼玲 

机构地区：[1]广州市胸科医院内科,510095

出　　处：《实用医学杂志》2015年第9期1482-1485,共4页The Journal of Practical Medicine

摘　　要：目的:总结淋巴结瘘型支气管结核支气管镜下特征及介入治疗效果。方法:对广州市胸科医院2010年1月至2013年6月经支气管镜诊疗的31例淋巴结瘘型支气管结核患者进行分析,回顾性分析其镜下特征和介入治疗次数、时间,评价治疗效果和并发症。结果:淋巴结瘘型支气管结核镜下表现:肉芽肿型为19.4%、坏死型为51.6%、混合型为25.8%、瘘孔型为3.2%。病灶夹杂灰黑色物或碳素沉着和反复钳夹仍陆续有坏死物自深处向腔内溃出是其特征。31例共76个瘘口,右侧为多。单个瘘口组中位治疗次数5次,中位治疗时间65 d;多个瘘口组中位治疗次数9次,中位治疗时间108 d,组间差异均有统计学意义(均P<0.05)。治疗有效率为98.7%。并发症为少量出血,发生率为2.1%。结论 :淋巴结瘘型支气管结核镜下表现有一定特征,经支气管镜钳夹加抗痨药灌注是一种安全、简单、有效的方法。Objective To explore the bronchoscopic features of endobronchial tuberculosis induced by lymphatic fistula and the efficacy of interventional treatment. Methods The data on 31 patients with endobronchial tuberculosis induced by lymphatic fistula who had received bronchoscopic diagnosis and treatment in our hospital during the period of January 2010 to June 2013 were reviewed. The bronchoscopic features , along with the frequency of interventional therapies and duration of the therapies , were retrospectively analyzed; and the efficacy of the therapies and the related complications were assessed. Rusults The endoscopic appearance showed： granuloma （19.4%）, necrosis （51.6%）, granuloma with necrosis （25.8%）, and fistulous opening （3.2%）. Dark gray matter or carbon deposition inside the lesions was the characteristics of endobronchial tuberculosis induced by lymphatic fistula. There were 76 orificium fistulae in 31 patients , mostly in the right side. The median frequency of treatment was five in patients with single orificium fistulae and the median treatment duration was 65 days; whereas the median frequency of treatment was nine in patients with multiple fistulae and the median treatment duration was 108 days. There were significant differences between the two groups （P 〈0.05 for both comparisons）. The effectiveness rate of treatment was 98.7%. The therapy-related complication was of a small amount of bleeding, with a rate of 2.1%. Conlusions Endobronchial tuberculosis induced by lymphatic fistula shows certain characteristics under bronchoscopic examination. Bronchoscopic clamping combined with infusions with antituberculosis agents is a safe, simple, effective therapeutic method.

关 键 词：结核 淋巴结 支气管镜 支气管瘘 

分 类 号：R521[医药卫生—内科学]