痰菌阴性肺结核支气管镜检诊断价值的临床观察

摘要

Objective To observe the clinical diagnosis rate of bronchoscopy in tuberculosis with negative sputum bacteria.Methods Observation was taken on 36 patients diagnosed as tuberculosis by bronchoscopy. All cases had atypical clinical manifestations, and had negative sputum acid-fast bacilli by repeated smear examination. They got poor curative effect through anti-infective therapy, and the imaging features were hard to be identified. Meanwhile, the possibilities of rheumatic disease and cardiovascular disease were eliminated.Results Bronchial biopsy, bronchial lung biopsy, brush inspection and bronchial washings were operated in all the 36 cases. There were 32 cases diagnosed as tuberculosis by bronchoscopic biopsy among the 36 cases, which accounted for 88.89%. There were 13 cases diagnosed after brush inspection, which accounted for 36.11%, including 2 cases of blind brush. There were 8 cases with positive acid-fast bacilli of bronchial washing fluid smear, which accounted for 22.22%. Through bronchoscopic visual inspection, there were 26 cases with different degrees of lesions in the 36 cases. There were 21 cases with hemorrhage and edema, accounting for 58.33%, 12 cases with bronchial stenosis, accounting for 33.33%, 11 cases with necrotic tissue and bronchial secretions coverage, accounting for 30.56%, 6 cases with granuloma-like changes, accounting for 16.67%, 2 cases with small nodular changes, accounting for 5.56%, 2 cases with rough bronchial mucosa, accounting for 5.56%, 3 cases with bleeding ulcer or erosion, accounting for 8.33%, 6 cases with closed bronchial mouth, accounting for 16.67%, and 4 cases of widened crest thickness, accounting for 11.11%.Conclusion In the atypical tuberculosis patients, bronchoscopy diagnosis rate increases significantly. That can provide timely treatment to patients with tuberculosis with negative sputum bacteria, and their mortality can be reduced. This method is worthy of clinical promotion.%目的：观察痰菌阴性肺结核支气管镜检的临床诊断率。方法36例经支气管镜检后确诊为肺结核的患者进行观察,所有病例均为临床表现不典型,反复痰涂片查抗酸杆菌阴性,经抗感染治疗疗效不佳,而影像表现亦难以鉴别。同时,排除风湿性疾病及心血管疾病。结果36例患者行支气管活检,支气管肺活检,刷检或支气管冲洗等方法后,36例病例中32例经支气管镜病理活检明确诊断为肺结核,占88.89%；13例刷检后确诊,占36.11%,包括2例盲刷确诊患者；支气管冲洗液涂片抗酸杆菌阳性8例,占22.22%。支气管镜下肉眼观察,36例患者中26例患者可见不同程度的病变。分别表现为：21例病变有出血水肿,占58.33%；12例支气管狭窄,占33.33%；11例坏死组织及支气管分泌物覆盖,占30.56%；6例肉芽肿样改变,占16.67%；2例小结节样改变,占5.56%；2例支气管黏膜粗糙,占5.56%；3例糜烂溃疡出血,占8.33%；6例支气管口闭陷,占16.67%；4例嵴厚度增宽,占11.11%。结论不典型肺结核患者,支气管镜检诊断率明显增加,让更多痰菌阴性肺结核患者得到及时治疗而降低死亡率,值得临床推广。