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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。
Objective To observe the clinical diagnosis rate of sputum bacillus negative tuberculosis bronchoscopy. Methods Thirty - six patients diagnosed as pulmonary tuberculosis after bronchoscopy were observed. All patients were atypical clinical manifestations. Acid - fast bacilli were negative in repeated sputum smear tests. The therapeutic effect was poor after anti - infective therapy and the imaging findings were also difficult to identify. At the same time, exclude rheumatic diseases and cardiovascular diseases. Results Thirty-six patients were diagnosed pulmonary tuberculosis by bronchoscopy biopsy after 36 bronchial biopsy, bronchoscopic biopsy, brush examination or bronchial irrigation. Among 36 cases, 32 %, Including 2 cases of blind brush diagnosed patients; bronchial smear acid-fast bacilli positive in 8 cases, accounting for 22.22%. Bronchoscopy under the naked eye, 36 patients in 26 patients showed varying degrees of disease. The results showed as follows: 21 cases had hemorrhage and edema, accounting for 58.33%; 12 cases had bronchial stricture, accounting for 33.33%; 11 cases were covered with necrotic tissue and bronchial secretions, accounting for 30.56%; 6 cases were granuloma-like, accounting for 16.67%; 2 Small nodules changed, accounting for 5.56%; 2 cases of bronchial mucosa rough, accounting for 5.56%; 3 cases of erosion ulcer hemorrhage, accounting for 8.33%; 6 cases of bronchial orifice closed, accounting for 16.67%; 4 cases ridge width, accounting for 11.11%. Conclusions Patients with atypical pulmonary tuberculosis, bronchoscopy significantly increased the rate of diagnosis, so that more sputum negative pulmonary tuberculosis patients receive timely treatment and reduce mortality, worthy of clinical promotion.