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目的探索支气管内膜结核(EBTB)的临床特征、早期确诊手段、疗效、方法。分析100例纤维支气管镜(纤支镜)确诊的EBTB患者临床表现、胸部X线(CT片)、治疗前后纤支镜检查结果。结果100例中主要症状包括:咳嗽84例,发热36例,胸痛32例,胸闷、气促各24例,咯血16例,消瘦8例。气道阻塞症状少,仅3例出现喘息。11例X线表示正常,CT检查无1例提示EBTB。纤支镜检查示36%的病例有炎症浸润型病变,8%有增殖型病变,24%为干酪坏死型,28%有狭窄闭塞型病变,8%大致正常。64例痰涂片行抗酸染色者中9例阳性,92例行纤支镜刷片检查者中80例阳性,62例行活组织检查者中19例证实为结核。治疗后纤支镜检查结果,36例炎症浸润型未见支气管狭窄,8例增殖型病变4例轻中度狭窄,24例干酪坏死型7例,出现支气管狭窄,28例狭窄闭塞型均出现不同程度支气管狭窄。结论EBTB缺乏特异性临床表现,胸部X线表现正常不能排除EBTB,CT诊断价值不高,确诊主要依靠纤支镜检查。对反复出现呼吸道症状经积极治疗无效者和不明原因低热者,应考虑EBTB的可能并及时行纤支镜检查。治疗结果表明EBTB早期诊断及治疗,可有效降低支气管狭窄发生率,降低肺不张及肺受损的发生率。
Objective To explore the clinical characteristics of bronchial tuberculosis (EBTB), early diagnosis methods, efficacy and methods. Analysis of 100 cases of bronchoscopy (bronchoscopy) confirmed EBTB patients with clinical manifestations, chest X-ray (CT film), before and after treatment bronchoscopy results. Results 100 cases of the main symptoms include: 84 cases of cough, fever in 36 cases, chest pain in 32 cases, chest tightness, shortness of breath of 24 cases, 16 cases of hemoptysis, weight loss in 8 cases. Airway obstruction less symptoms, only 3 cases wheezing. Eleven patients showed normal X-ray, none of CT examination showed EBTB. Bronchoscopy revealed 36% of cases with inflammatory infiltrates, 8% with proliferative lesions, 24% with cheese necrosis, 28% with narrow occlusive lesions, and approximately 8%. Of the 64 sputum smears, 9 were positive for acid-fast staining, 80 were positive for 92 biopsy samples, and 19 of 62 biopsies were confirmed as tuberculosis. Bronchoscopy results after treatment showed that there were no bronchoconstriction in 36 inflammatory infiltrates, mild to moderate stenosis in 8 cases of proliferative lesions, 7 cases of necrosis in 24 cases, bronchial stenosis and 28 cases of occlusive occlusion Degree of bronchoconstriction. Conclusion EBTB lacks specific clinical manifestations, chest X-ray can not rule out the normal EBTB, CT diagnosis is not high, the diagnosis mainly depends on bronchoscopy. Repeated respiratory symptoms of active treatment ineffective and unexplained fever, should consider the possibility of EBTB and timely fiberoptic bronchoscopy. Treatment results show that EBTB early diagnosis and treatment, can effectively reduce the incidence of bronchial stenosis, reduce the incidence of atelectasis and lung damage.