纤支镜对41例支气管结核的诊断意义

目的：探索气管-支气管结核的临床特征，分析纤维支气管镜（FB）对支气管结核的检出率及镜下特征，探讨其诊断价值。方法：分析41例经纤维支气管镜确诊的气管-支气管结核的纤维支气管镜下表现、临床症状、胸部X线及实验室检查情况。结果：纤支镜检查显示：Ⅰ型11例，占26．83％；Ⅱ型8例，占19．51％；Ⅲ型17例，占41．46％；Ⅳ型5例，占12．20％。镜下所见管腔内各种类型病变互有重迭，其病变表现具有一定特征。31例镜检前后进行痰菌涂片检查2～6次／例，仅6例阳性。41例经FB刷片行抗酸杆菌检查，有12例阳性（阳性率29．3％）。41例行活组织检查证实为结核36例（87．80％）。结论：气管-支气管结核缺乏特异性临床表现，胸部X线表现正常并不能排除支气管结核，确诊主要依靠纤支镜下活检病理、刷检涂片及痰结核菌检查。对不明原因低热和呼吸道症状经积极抗炎治疗无效者，应怀疑支气管结核及早行纤支镜检查。

Probe Diagnostic Value of Bronchofiberscope in Patients with Bronchial Tuberculosis: 41 Cases Repont

Objective: To investigate the clinical characteristics of bronchial tuberculosis by analysis of the positive rate and characteristics of bronchial tuberculosis finding by bronchof iberscope, to probe its diagnostic value. Methods: Analysis to the endoscopic manifestation, clinical symptoms, X-ray film, laboratory data of 41 cases of bronchial tuberculosis diagnosed by bronchofiberscope. Results: Bronchoscope demonstrate: 11 cases were type I, which accounted for 26. 83% ; 8 cases were type II, which accounted for 19. 51 %; 17 cases were type III, which accounted for 41.46% ;5cases were type IV, which took 12. 00%. Under endoscope, there were overlapping among these types, and some characteristics did be found. Before bronchofiberscope, being done, 2-6 times of sputum examination per person have been done in 31 cases, only 6 cases were positive. By smear sample from bronchofiberscope, 12 cases were positive in 41 cases(took 29. 3 %), 36 cases were diagnosed by biopsy(took 87. 80%). Conclusion:Bronchial TB is lack of specific clinical manifestation. Normal X - ray does not mean that TB could be excluded. Its diagnosis could be done by endoscopic biopsy, endoscopic brush and smear and sputum examination. Patients with lower fever and respiratory symptom should receive bronchofiberscope, examination after long time of treatment.