目的探讨不典型肺结核的特点及基层医院支气管镜对不典型肺结核的诊断意义。方法对应用支气管镜确诊的28例临床不典型、痰菌阴性的肺结核患者的临床资料进行回顾性分析。结果本研究中28例患者的临床症状缺乏特征性,临床影像学缺乏典型性,胸部影像学检查以肺内片状阴影(57.1%)多见,影像学无明显异常者占14.3%。本研究28例支气管镜下见支气管黏膜有异常改变,炎症浸润型病变20例,干酪坏死型病变2例,肉芽增生型型病变4例,纤维狭窄型病变2例。其中刷检涂片找抗酸杆菌阳性22例(78.6%),活检有结核病理改变6例(21.4%),术后痰菌阳性6例(21.4%),三者联合确诊28例(100%)。结论支气管镜对不典型肺结核的诊断具有重要的临床应用价值,值得基层医院推广应用。 Objective To investigate the characteristics of atypical pulmonary tuberculosis and the diagnostic significance of bronchoscopy in primary hospital to atypical pulmonary tuberculosis. Methods The clinical data of 28 cases of atypical and sputum negative pulmonary tuberculosis diagnosed by bronchoscopy were analyzed retrospectively. Results The clinical manifestations of 28 patients in this study were characterized by a lack of typical features of clinical imaging. Chest imaging findings were more common in intrapulmonary flaps (57.1%), with no significant abnormalities in imaging findings (14.3%). In this study, bronchial mucosa abnormalities were observed in 28 cases of bronchoscope. There were 20 cases of inflammatory infiltrate, 2 cases of necrosis of cheese, 4 cases of granulation proliferation and 2 cases of stenosis of bronchioles. Among them, 22 cases (78.6%) were positive for acid-fast bacilli, 6 cases (21.4%) were pathological changes of biopsy, and 6 cases (21.4%) were sputum positive after operation. ). Conclusion Bronchoscopy has an important clinical value in the diagnosis of atypical pulmonary tuberculosis and is worth popularizing and applying in primary hospitals.