中国实用医药
中國實用醫藥
중국실용의약
CHINA PRACTICAL MEDICAL
2015年
1期
1-2,3
,共3页
雷艳萍%马恩茂%吴有明%郭桂林%贺卫国%唐一叶
雷豔萍%馬恩茂%吳有明%郭桂林%賀衛國%唐一葉
뢰염평%마은무%오유명%곽계림%하위국%당일협
痰抗酸杆菌阴性%肺结核%支气管镜检%病理活检
痰抗痠桿菌陰性%肺結覈%支氣管鏡檢%病理活檢
담항산간균음성%폐결핵%지기관경검%병리활검
Negative sputum acid-fast bacilli%Tuberculosis%Bronchoscopy%Biopsy
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。
目的：觀察痰菌陰性肺結覈支氣管鏡檢的臨床診斷率。方法36例經支氣管鏡檢後確診為肺結覈的患者進行觀察,所有病例均為臨床錶現不典型,反複痰塗片查抗痠桿菌陰性,經抗感染治療療效不佳,而影像錶現亦難以鑒彆。同時,排除風濕性疾病及心血管疾病。結果36例患者行支氣管活檢,支氣管肺活檢,刷檢或支氣管遲洗等方法後,36例病例中32例經支氣管鏡病理活檢明確診斷為肺結覈,佔88.89%；13例刷檢後確診,佔36.11%,包括2例盲刷確診患者；支氣管遲洗液塗片抗痠桿菌暘性8例,佔22.22%。支氣管鏡下肉眼觀察,36例患者中26例患者可見不同程度的病變。分彆錶現為：21例病變有齣血水腫,佔58.33%；12例支氣管狹窄,佔33.33%；11例壞死組織及支氣管分泌物覆蓋,佔30.56%；6例肉芽腫樣改變,佔16.67%；2例小結節樣改變,佔5.56%；2例支氣管黏膜粗糙,佔5.56%；3例糜爛潰瘍齣血,佔8.33%；6例支氣管口閉陷,佔16.67%；4例嵴厚度增寬,佔11.11%。結論不典型肺結覈患者,支氣管鏡檢診斷率明顯增加,讓更多痰菌陰性肺結覈患者得到及時治療而降低死亡率,值得臨床推廣。
목적：관찰담균음성폐결핵지기관경검적림상진단솔。방법36례경지기관경검후학진위폐결핵적환자진행관찰,소유병례균위림상표현불전형,반복담도편사항산간균음성,경항감염치료료효불가,이영상표현역난이감별。동시,배제풍습성질병급심혈관질병。결과36례환자행지기관활검,지기관폐활검,쇄검혹지기관충세등방법후,36례병례중32례경지기관경병리활검명학진단위폐결핵,점88.89%；13례쇄검후학진,점36.11%,포괄2례맹쇄학진환자；지기관충세액도편항산간균양성8례,점22.22%。지기관경하육안관찰,36례환자중26례환자가견불동정도적병변。분별표현위：21례병변유출혈수종,점58.33%；12례지기관협착,점33.33%；11례배사조직급지기관분비물복개,점30.56%；6례육아종양개변,점16.67%；2례소결절양개변,점5.56%；2례지기관점막조조,점5.56%；3례미란궤양출혈,점8.33%；6례지기관구폐함,점16.67%；4례척후도증관,점11.11%。결론불전형폐결핵환자,지기관경검진단솔명현증가,양경다담균음성폐결핵환자득도급시치료이강저사망솔,치득림상추엄。
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.
